Vol.11, No 3, 2004 pp. 123 - 126
UC 616.155.392-053.2
BONE CHANGES, MINERAL HOMEOSTASIS
IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA
Gordana Kostić, Zlatko Đurić, Gordana Bunjevački,
Ljiljana Šaranac, Lana Mačukanović-Golubović, Borislav Kamenov
Clinic of Pediatrics, Clinical Centre, Faculty of Medicine Niš, Serbia
and Montenegro
E-mail: gogak@medfak ni.ac.yu
Summary. In childhood acute lymphobastic leukemia [ALL] skeletal
changes are frequently found at the time of diagnosis and treatment, including:
metafyseal lines, periostal reaction, lysis, sclerosis, osteoporosis and
occasionally spontaneous fracture.
Different factors, including the disease itself, may be responsible
for a defective bone homeostasis in these patients. Solubil products of
malignant cells like the osteoclast activated factor (OAF), lymphotoxin,
IL-1, tumor necrosis factor (TNF) and other cytokines may cause bone demineralization.
Citotoxic drugs, like methotrexate corticosteroids and radiotherapy, have
been incriminated as elements of the treatment that may cause bone changes.
Prospective analysis of the bone and mineral status in 108 children
with ALL was performed. Markers of bone turnover (Ca, P, Mg homeostasis
in urine and serum, osteocalcin and PTH) were measured before the initiation
of the therapy, on the 28th day of therapy and six months after it. The
bone mass was determined on the x-ray and densitometry was measured.
At the time of diagnosis musculoskeletal pain was present in 37.5%
of patients. It was common in children with better prognosis (CD 10 immunophenotype,
low leucocytes count, L1-morphology).
We found hypocalcemia, hypomagnesaemia and calciuria. PTH and osteocalcin
decreased at the time of diagnosis 80% children with ALL had decrease bone
mineral density.
Key words: Acute lymphoblastic leukemia, childhood, bone changes
KOSTNE PROMENE, MINERALNA HOMEOSTAZA
U DECE SA AKUTNOM LIMFOBLASTNOM LEUKEMIJOM
Kratak sadržaj: Deca koja boluju od akutne limfoblastne leukemije
imaju skeletne promene na početku bolesti i u toku tretmana. Uočavaju se
metafizealne linije, periostalna reakcija, osteoliza, osteoporoza i spontane
frakture. Različiti faktori, uključujući i samu bolest, mogu biti odgovorni
za izmenjenu kostnu homeostazu kod tih pacijenata. Solubilni produkti malignih
ćelija kao što su osteoklast aktivirajući faktor (OAF), limfotoksin, IL-1,
TNF i drugi citokini mogu biti uzrok kostne demineralizacije. Citotoksični
lekovi kao što je methotrexat, zatim kortikoterapija i radioterapija, smatraju
se elementima koji dovode do promena kostnog metabolizma. Urađena je prospektivna
analiza kostnog i mineralnog statusa 108 dece sa akutnom limfoblastnom
leukemijom. Markeri kostnog "turnover"-a (Ca, P, Mg u urinu i serumu, osteokalcin
i parathormon) mere se na početku bolesti, 28. dana posle indukcije i nakon
završene terapije.
Muskuloskeletni bol uočava se kod 37,5% pacijenata. Ovaj simptom je
u korelaciji sa parametrima bolje prognoze (CD 10 imunofenotip, manji broj
leukocita na početku bolesti, L1 morfologija). Uočava se hipokalcemija,
hipomagnezijemija, kalciurija i smanjenje PTH i osteokalcina u trenutku
dijagnoze. 80% dece ima smanjenje kostne gustine.
Ključne reči: Akutna limfoblastna leukemija dece, kostne promene
