van der Sluis I M, van den Heuvel-Eibrink M M, Hählen K, Krenning E P, de Muinck Keizer-Schrama S M
Division of Endocrinology, Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
Med Pediatr Oncol. 2000 Oct;35(4):415-20. doi: 10.1002/1096-911x(20001001)35:4<415::aid-mpo4>3.0.co;2-9.
Childhood leukemia has increasing numbers of survivors, so more emphasis is being placed on long-term effects. The ALL-6 protocol of the Dutch Childhood Leukemia Study Group involved high-dose dexamethasone and methotrexate and no cranial irradiation. Therefore, we studied the long-term effects on bone mineral density (BMD), body composition, and growth in survivors of non-high-risk ALL treated with the ALL-6 protocol.
Twenty-three subjects (12.2-25.4 years) participated in this cross-sectional study. Mean follow-up was 9.6 years (range 7.9-11.4 years). BMD of lumbar spine (LS) and total body (TB) and body composition were measured by dual energy X-ray absorptiometry; results are expressed as standard deviation scores (SDS). Bone mineral apparent density (BMAD(LS)) was calculated to correct for bone size. A questionnaire was administered to determine physical activity, calcium intake, and medical history.
Mean SDS for BMD(LS), BMD(TB), and BMAD(LS) were normal. None of the subjects had BMD below -2 SDS; one subject had BMAD(LS) below -2 SDS. Mean SDS for lean body mass, percentage fat, and height were not significantly different from zero. Calcium intake correlated positively with BMD. Nine subjects reported traumatic fractures (eight during or shortly after therapy).
Ten years after ALL-6 treatment, no long-term side effects on height, BMD, or body composition were found in this small group of patients, despite high-dose dexamethasone and methotrexate. This study suggests that ALL treatment without cranial irradiation might not be associated with long-term side effects on growth and BMD.
儿童白血病幸存者数量不断增加，因此人们越来越关注其长期影响。荷兰儿童白血病研究组的ALL - 6方案采用了高剂量地塞米松和甲氨蝶呤，且未进行颅脑照射。因此，我们研究了采用ALL - 6方案治疗的非高危急性淋巴细胞白血病（ALL）幸存者的骨密度（BMD）、身体成分和生长的长期影响。
23名受试者（年龄12.2 - 25.4岁）参与了这项横断面研究。平均随访时间为9.6年（范围7.9 - 11.4年）。采用双能X线吸收法测量腰椎（LS）和全身（TB）的骨密度以及身体成分；结果以标准差分数（SDS）表示。计算骨矿物质表观密度（BMAD(LS)）以校正骨骼大小。通过问卷调查确定身体活动、钙摄入量和病史。
BMD(LS)、BMD(TB)和BMAD(LS)的平均SDS均正常。没有受试者的骨密度低于 -2 SDS；一名受试者的BMAD(LS)低于 -2 SDS。瘦体重、脂肪百分比和身高的平均SDS与零无显著差异。钙摄入量与骨密度呈正相关。9名受试者报告有创伤性骨折（8例发生在治疗期间或治疗后不久）。
在ALL - 6治疗10年后，尽管使用了高剂量地塞米松和甲氨蝶呤，但在这一小群患者中未发现对身高、骨密度或身体成分的长期副作用。这项研究表明，不进行颅脑照射的ALL治疗可能与对生长和骨密度的长期副作用无关。
