EVALUATION OF BONE MINERAL DENSITY IN YOUNG ADULT ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) PATIENTS: A single center Egyptian experience

Acute lymphoblastic leukemia (ALL) is a clonal hematological disease characterized by inadequate normal hematopoiesis secondary to excessive proliferation of leukemic blasts and their impaired differentiation. Bone health and the loss of bone density are impor¬tant clinical concerns for patients with cancer who may be at risk for primary osteoporosis because of aging and other risk factors reference. They may have the added risk for cancer treatment-induced bone loss (CTIBL), which also could be termed secondary osteoporosis related to therapy and cancer as in (ALL). This study was conducted on 25 Adult patients aged 20-45 years, with newly diagnosed ALL, presenting to Ain Shams University hospitals were recruited to this cross-sectional prospective study if they were eligible for induction therapy. Bone mineral density (BMD) was evaluated by using dual-energy X-ray absorptiometry (DXA) for all studied subjects at presentation and at D28 for evaluable patients. Measurements were performed at the lumbar spine (L2 to L4) and the left femoral neck using a Lunar DPX-L scanner. Bone mineral density was expressed in grams per square centimeter (g/cm2). Lumbar spine and femoral neck BMD was evaluated in all patients at diagnosis and after receiving induction chemotherapy. T-score was used to describe BMD (normal, osteopenia or osteoporosis) according to WHO classification . None of the patients had osteoporosis either in the pre or post treatment evaluation (T-score < -2.5). Seven patient (28%) fulfilled the WHO criteria for osteopenia in the lumbar spine at diagnosis (T- score -1 to -2.5). At post-treatment evaluation, ten patients (40%) were found to have osteopenia as assessed at the lumbar spine. Yet the difference in bone density at the lumbar spine did not reach statistical significance (p-value >0.05). There was statistically significant reduction in the BMD at the left femoral neck, in the post treatment as compared to the pre treatment evaluation, with p-value <0.001 conclusion :Our results raised the issue that Skeletal morbidity, characterized by bone pain, osteonecrosis, fractures, loss of mobility, bone deformation, or osteopenia, is frequently encountered in ALL patients affected by their hematological malignancy. Clinically important sites for evaluation of osteopenia/ osteoporosis in adult are the lumbar spine (L2-L4), and femoral neck.