Predictors of Vertebral Deformity in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: The PETALE Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 106; no. 2; pp. 512 - 525
• Main Authors: Fiscaletti, Melissa, Samoilenko, Mariia, Dubois, Josée, Miron, Marie-Claude, Lefebvre, Geneviève, Krajinovic, Maja, Laverdière, Caroline, Sinnett, Daniel, Alos, Nathalie
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.02.2021
• Subjects: Acute lymphoblastic leukemia; Acute lymphocytic leukemia; Back pain; Backache; Cancer; Children; Clinical trials; Corticosteroids; Dual energy X-ray absorptiometry; Glucocorticoids; Hematopoietic stem cells; Leukemia; Lymphatic leukemia; Oncology, Experimental; Pain; Risk factors; Sex differences; Sex ratio; Spine; Stem cell transplantation; Transplantation; Vertebrae; Canada; Quebec; vertebral deformities; childhood acute lymphoblastic leukemia; vertebral fractures; long-term survivors
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/clinem/dgaa806

Abstract Background The prevalence of vertebral deformities in long-term survivors of childhood acute lymphoblastic leukemia (ALL) is unknown. Our objectives were to identify the prevalence of vertebral deformities and their risk factors among long-term childhood ALL survivors. Methods/Results We recruited 245 (49% male) long-term childhood ALL survivors from the Preventing Late Adverse Effects of Leukemia Cohort (French-Canadian ALL survivors treated between the years 1987 and 2010 with the Dana Farber Cancer Institute clinical trials protocols, who did not experience disease relapse and/or receive hematopoietic stem cell transplant). Median age at recruitment was 21.7 years (range, 8.5-41) and median time since diagnosis was 15.1 years (range, 5.4-28.2). All participants underwent spine radiograph and dual-energy X-ray absorptiometry scans. The prevalence of vertebral deformity was 23% with 88% classified as grade 1 according to the Genant method. The majority of vertebral deformities were clinically silent. Regression analysis confirmed male sex (risk ratio [RR] = 1.94; 95% confidence interval [CI], 1.16-3.24; P = 0.011), higher glucocorticoid cumulative dose (RR = 1.05; 95% CI, 1.00-1.10; P = 0.032), and back pain (RR = 2.44; 95% CI, 1.56-3.84; P < 0.001) as predictors of prevalent vertebral deformity. Sex differences in vertebral deformity predictors emerged. Conclusions We report a significant prevalence of vertebral deformities in this young cohort. Male sex, cumulative glucocorticoid dose, and back pain were identified as predictors of prevalent vertebral deformity. Back pain emerging as a strong predictor of vertebral deformity underscores the importance of ongoing bone health surveillance in survivors with persistent vertebral deformities treated with these earlier protocols.