Scientific Publications Database

Article Title: Impact of Vertebral Fractures and Glucocorticoid Exposure on Height Deficits in Children During Treatment of Leukemia
Authors: Ma, Jinhui; Siminoski, Kerry; Alos, Nathalie; Halton, Jacqueline; Ho, Josephine; Cummings, Elizabeth A.; Shenouda, Nazih; Matzinger, Mary Ann; Lentle, Brian; Jaremko, Jacob L.; Wilson, Beverly; Stephure, David; Stein, Robert; Sbrocchi, Anne Marie; Rodd, Celia; Lewis, Victor A.; Laverdiere, Caroline; Israels, Sara; Grant, Ronald M.; Fernandez, Conrad, V; Dix, David B.; Couch, Robert; Cairney, Elizabeth; Barr, Ronald; Atkinson, Stephanie; Abish, Sharon; Moher, David; Rauch, Frank; Ward, Leanne M.; Kloiber, Reinhard; Lewis, Victor; Midgley, Julian; Miettunen, Paivi; Lentle, Brian C.; Blydt-Hansen, Tom; Cabral, David; Houghton, Kristin; Nadel, Helen R.; Hay, John; Feber, Janusz; Jurencak, Roman; Ma, Jinhui; Matzinger, MaryAnn; Roth, Johannes; Watanabe-Duffy, Karen; Clarson, Cheril; Filler, Guido; Grimmer, Joanne; McKillop, Scott; Sparrow, Keith; Huber, Adam M.; Lang, Bianca; O'Brien, Kathy; Arora, Steve; Dent, Peter B.; Coblentz, Craig; Larche, Maggie; Bell, Lorraine; LeBlanc, Claire; Scuccimarri, Rosie; Dubois, Josee; Phan, Veronique; Saint-Cyr, Claire; Ellsworth, Janet; Jaremko, Jacob; Grant, Ronald; Charron, Martin; Hebert, Diane; Gaboury, Isabelle; Oen, Kiem; Pinsk, Maury; Reed, Martin; Taback, Shayne
Journal: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM Volume 104 Issue 2
Date of Publication:2019
Abstract:
Objective: To assess the effect of vertebral fractures (VF) and glucocorticoid (GC) exposure on height deficits in children during treatment of acute lymphoblastic leukemia (ALL).Methods: Children with ALL treated without cranial radiation therapy (n = 160; median age, 5.1 years; 58.1% male) were followed prospectively for 6 years. Spinal deformity index (SDI) was used to quantify VF status.Results: Baseline height z score +/- SD was 0.3 +/- 1.2. It fell by 0.5 +/- 0.4 in the first 6 months for boys and by 0.4 +/- 0.4 in the first 12 months for girls (P < 0.01 for both) and then subsequently recovered. The prevalence of VF peaked at 1 year (17.6%). Among those with VF, median SDI rose from 2 [interquartile range (IQR): 1, 7] at baseline to 8 (IQR: 1, 8) at 1 year. A mixed model for repeated measures showed that height z score declined by 0.13 (95% CI: 0.02 to 0.24; P= 0.02) for each 5-unit increase in SDI during the previous 12 months. Every 10 mg/m(2) increase in average daily GC dose (prednisone equivalent) in the previous 12 months was associated with a height z score decrement of 0.26 (95% CI: 0.20 to 0.32; P < 0.01).Conclusions: GC likely plays a major role in the observed height decline during therapy for ALL. Because only a minority of children had VF, fractures could not have contributed significantly to the height deficit in the entire cohort but may have been important among the subset with VF.