Background: Hematopoietic stem cell transplantation (HSCT) has improved the prognosis of children with malignant hematologic disease. However, it has had significant adverse effects on the endocrine system, including bone health. Limited studies are available to assess osteoporosis in survivors of adolescents after HSCT.
Objective and hypotheses: We investigate the bone mineral density (BMD) and endocrinopathy/treatment factors associated with low BMD in adolescents with leukemia treated with HSCT.
Method: Demographic measurements and dual-energy X-ray aborptiometry assessment of 61 adolescents (F=28, M=33; lymphoid=28, myeloid=33) over 14 years of age (16.6±1.3) who were referred to the pediatric endocrinology clinic between September 2009 and September 2014 after HSCT at the Catholic HSCT center were evaluated. Low BMD was classified when lumbar spine (LS)-BMD SDS adjusted for age and current height was below −2.0.
Results: Twenty-three (37.7%) out of 61 patients revealed low BMD. In low BMD group, LS-SDS was -3.2±1.1. In low BMD group, the incidence of chronic graft-versus-host disease (cGVHD) (73.9% vs 42.1%, P<0.019), and hypogonadism (78.3% vs 44.7%, P<0.016) were higher than normal BMD group. There were no significant differences of age, sex, weight-SDS, weight-SDS, diagnosis, preparative regimen, acute-GVHD, duration of steroid or cyclosporine treatment for GVHD, growth hormone deficiency. In a multivariate logistic regression analysis, the development of hypogonadism was associated with low BMD (β=1.371, P=0.026).
Conclusion: One thirds of adolescents with leukemia treated with HSCT showed low BMD. Monitoring these patients at regular intervals may be necessary for improving bone health during adolescence and adulthood.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology