从儿童期急性白血病幸存的成人的骨密度：造血干细胞移植和其他治疗形式的影响

Femoral and lumbar bone mineral densities (BMDs) were measured in 159 adults enrolled in the Leucémies de l'Enfant et de l'Adolescent program, a French prospective multicentric cohort of childhood leukemia survivors. BMDs were expressed as Z-scores, and multivariate linear regression analyses were used to construct association models with potential risk factors. Mean age at evaluation and follow-up was 23 and 14.7years, respectively. In the whole cohort, mean femoral Z-score was −0.19±0.08. Two factors were associated with lower femoral BMD transplantation (−0.49±0.15 vs −0.04±0.10 in the chemotherapy group; P=.006) and female sex (−0.34±0.10 vs −0.03±0.13; P=.03). Among patients who received a transplant, the only significant risk factor was hypogonadism (−0.88±0.16 vs −0.10±0.23; P=.04). A slight reduction in lumbar BMD (mean Z-score, −0.37±0.08) was detected in the whole cohort without difference between the transplantation and chemotherapy groups. Among patients who received a transplant, younger age at transplantation was correlated with a low lumbar BMD (P=.03). We conclude that adults who had received only chemotherapy for childhood leukemia have a slight reduction in their lumbar BMD and a normal femoral BMD. Patients who received a transplant with gonadal deficiency have a reduced femoral BMD which might increase the fracture risk later in life.