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Osteopenia, excess adiposity and hyperleptinaemia during 2 years of treatment for childhood acute lymphoblastic leukaemia without cranial irradiation

Osteopenia, excess adiposity and hyperleptinaemia during 2 years of treatment for childhood acute lymphoblastic leukaemia without cranial irradiation
Osteopenia, excess adiposity and hyperleptinaemia during 2 years of treatment for childhood acute lymphoblastic leukaemia without cranial irradiation

Objective Osteopenia and excess adiposity occur following treatment of childhood acute lymphoblastic leukaemia (ALL) and the use of cranial irradiation is thought to be a significant contributory factor. Hyperleptinaemia has also been demonstrated following cessation of treatment for childhood ALL. Therefore a prospective study was undertaken to evaluate serial changes in percentage bone mineral content (BMC), adiposity and serum leptin concentrations during 2 years of treatment of children with ALL with chemotherapy but without cranial irradiation.

Design and patient Only patients treated using the MRC ALL 97/ALL 97 (modified 99) protocols for childhood ALL were eligible for entry into the study. A total of 14 patients (seven male, with a median age of 7·5 years (range 3·4–16·7 years) were recruited. Serial dual energy X-ray absorptiometry (DEXA) scanning was undertaken at diagnosis and during two years of treatment. Serum leptin concentrations were determined at the same time as the scans.

Results Reductions in %BMC were observed at the hip and lumbar spine by 12 months (P < 0·01) and remained low after 24 months of treatment. Subanalysis of %BMC measurements at the hip demonstrated a greater reduction in %BMC at the trochanteric region compared to the femoral neck. The percentage corrected fat mass increased from 6 months whereas the body mass index (BMI) standard deviation score (SDS) was increased after 24 months of treatment (P < 0·05). Serum leptin concentrations increased following 24 months of therapy (P < 0·05).

Conclusions Children treated for ALL with contemporary regimens have a predisposition to osteopenia, excess adiposity and hyperleptinaemia during treatment without cranial irradiation administration. We speculate that in addition to glucocorticoid administration, leptin resistance may account in part for these observations.

neck, serum, bone, male, body mass index, clinical-trial, preschool, research, design, obesity, bone diseases, diagnosis, female, time, prospective studies, pathology, wales, research support, health, metabolism, treatment, precursor cell lymphoblastic leukemia-lymphoma, humans, leptin, blood, therapy, metabolic, childhood, child, spine, adolescent, cranial irradiation, complications, hip, drug therapy, observation, patients
0300-0664
358-365
Davies, J.H.
9f18fcad-f488-4c72-ac23-c154995443a9
Evans, B.A.
2679ef85-28bc-4ee9-8c3f-8550d40e5f63
Jones, E.
52e90d30-403c-44c5-9cb4-238fb75641d3
Evans, W.D.
5a74a633-1556-44f6-b123-bcbfef1012a1
Jenney, M.E.
4aa4993c-7f3f-4662-8f52-d084d67a1540
Gregory, J.W.
f14bbe24-2378-4a70-991d-4bbf8fa66ac5
Davies, J.H.
9f18fcad-f488-4c72-ac23-c154995443a9
Evans, B.A.
2679ef85-28bc-4ee9-8c3f-8550d40e5f63
Jones, E.
52e90d30-403c-44c5-9cb4-238fb75641d3
Evans, W.D.
5a74a633-1556-44f6-b123-bcbfef1012a1
Jenney, M.E.
4aa4993c-7f3f-4662-8f52-d084d67a1540
Gregory, J.W.
f14bbe24-2378-4a70-991d-4bbf8fa66ac5

Davies, J.H., Evans, B.A., Jones, E., Evans, W.D., Jenney, M.E. and Gregory, J.W. (2004) Osteopenia, excess adiposity and hyperleptinaemia during 2 years of treatment for childhood acute lymphoblastic leukaemia without cranial irradiation. Clinical Endocrinology, 60 (3), 358-365. (doi:10.1111/j.1365-2265.2003.01986.x).

Record type: Article

Abstract

Objective Osteopenia and excess adiposity occur following treatment of childhood acute lymphoblastic leukaemia (ALL) and the use of cranial irradiation is thought to be a significant contributory factor. Hyperleptinaemia has also been demonstrated following cessation of treatment for childhood ALL. Therefore a prospective study was undertaken to evaluate serial changes in percentage bone mineral content (BMC), adiposity and serum leptin concentrations during 2 years of treatment of children with ALL with chemotherapy but without cranial irradiation.

Design and patient Only patients treated using the MRC ALL 97/ALL 97 (modified 99) protocols for childhood ALL were eligible for entry into the study. A total of 14 patients (seven male, with a median age of 7·5 years (range 3·4–16·7 years) were recruited. Serial dual energy X-ray absorptiometry (DEXA) scanning was undertaken at diagnosis and during two years of treatment. Serum leptin concentrations were determined at the same time as the scans.

Results Reductions in %BMC were observed at the hip and lumbar spine by 12 months (P < 0·01) and remained low after 24 months of treatment. Subanalysis of %BMC measurements at the hip demonstrated a greater reduction in %BMC at the trochanteric region compared to the femoral neck. The percentage corrected fat mass increased from 6 months whereas the body mass index (BMI) standard deviation score (SDS) was increased after 24 months of treatment (P < 0·05). Serum leptin concentrations increased following 24 months of therapy (P < 0·05).

Conclusions Children treated for ALL with contemporary regimens have a predisposition to osteopenia, excess adiposity and hyperleptinaemia during treatment without cranial irradiation administration. We speculate that in addition to glucocorticoid administration, leptin resistance may account in part for these observations.

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More information

Published date: March 2004
Keywords: neck, serum, bone, male, body mass index, clinical-trial, preschool, research, design, obesity, bone diseases, diagnosis, female, time, prospective studies, pathology, wales, research support, health, metabolism, treatment, precursor cell lymphoblastic leukemia-lymphoma, humans, leptin, blood, therapy, metabolic, childhood, child, spine, adolescent, cranial irradiation, complications, hip, drug therapy, observation, patients
Organisations: Medicine

Identifiers

Local EPrints ID: 59654
URI: https://eprints.soton.ac.uk/id/eprint/59654
ISSN: 0300-0664
PURE UUID: 6db20faf-e813-4209-9c06-85f9e0b42797

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Date deposited: 04 Sep 2008
Last modified: 13 Mar 2019 20:30

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Contributors

Author: J.H. Davies
Author: B.A. Evans
Author: E. Jones
Author: W.D. Evans
Author: M.E. Jenney
Author: J.W. Gregory

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