Abstract
Acute lymphoblastic leukemia is the most prevalent cancer in children. As an increasing number of cancer survivors reaches adulthood, there may be consequences of the treatment, and there is an issue if low bone mass might be included as a significant late effect. Acute lymphoblastic leukemia patients may have their bone mass compromised during therapy and many years after its withdrawal, but the degree of bone mass decline or recovery are not well elucidated to date. Survivors of stem cell transplantation for leukemia have additional risk factors for bone loss and should be evaluated with caution. Our target is to make a warning about the difficulties in assessing and interpreting bone mass in children and adolescents, the limitations in this assessment in acute lymphoblastic leukemia young survivors (including survivors of stem cell transplantation), the possibility of misdiagnoses, the reasons (if there are any) of low bone mass in this particular group of cancer survivors, as well as consider the therapeutic issues available.
Highlights
Acute Lymphoblastic Leukemia (ALL) is the most prevalent cancer in children [1]
This special and growing population have mixed health problems, habitually underwent multiple and different chemotherapy protocols and/or radiation treatment schedules previously to Stem Cell Transplantation (SCT), that might lead to decreased gonadal function and fertility, which is one of the most important factors in determining reduced Bone Mineral Density (BMD) in these patients [40,58]
Even though the treatment of underlying leukemia was of primary importance in decreasing pain and restoring normal bone mass, pamidronate therapy resulted in pain control, improved function and prevented new fractures [67]
Summary
As an increasing number of cancer survivors reaches adulthood, there may be consequences of the treatment, including adiposity, metabolic syndrome traits [2,3,4,5,6,7,8,9] and occasionally low bone mass [10,11,12,13,14,15,16,17,18], which is a condition not totally understood, so far. This paper discusses the difficulties of assessing and interpreting bone mass in children and adolescents, the limitations on this assessment in ALL young survivors, the particularities of survivors of hematopoietic Stem Cell Transplantation (SCT), the possible reasons
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