PB1995 THE EFFECTS OF ANTITUMOR THERAPY ON BONE REMODELING IN PATIENTS WITH HODGKIN'S LYMPHOMA

Abstract

Background:Cures have been achieved in a significant proportion of patients with Hodgkin lymphoma (HL) for many years. Treatment for HL has been associated with adverse late effects. One of those consequences of antitumor therapy may be a change in bone mineral density (BMD). Hemoblastosis is considered as a strong risk factor for secondary osteoporosis and major low‐energy fractures. The decrease in BMD can be associated with polychemotherapy, including various combinations of cytostatic drugs and glucocorticoids, as well as with hypogonadism caused by toxic effects of radiotherapy and chemotherapy, tumor process, low physical activity and other factors.Aims:To assess the bone mineral density (BMD) in patients with HL.Methods:The study included 103 patients with HL from the City Hematology Center of Novosibirsk, from 19 to 72 years of age (median 49 years [33;55]). The disease was staged according to the Ann Arbor staging system: 55 patients had early stage disease and 48 patients had advanced stage disease (stage III to IV). All subjects received first‐line regimens (ABVD, BEACOPP‐14, et al.). Eighteen patients with advanced stages and unfavorable prognosis obtained second‐line regimens (DHAP, ESHAP). Radiotherapy was performed in 57 (55,3%) individuals. Complete remission was achieved in 60 of 103 patients (58,2%), and partial remission was recorded in 32 ones (31%). The BMD was assessed by dual‐energy X‐ray absorptiometry with GE Lunar Prodigy densitometer (USA). The assessed variables were BMD and T‐ or Z‐criterion (when appropriate) at the lumbar spine (L1–L4), proximal femur, femoral neck and forearm of a non‐dominant arm. Fracture Risk Assessment Tool (WHO FRAX, web version 3.8, adjusted for Russia) was used to determine the risk of major osteoporotic fractures.Results:The decreased BMD was revealed in 47 observed HL subjects (45,6%), 30 of them diagnosed osteoporosis. The decline in BMD was more frequent in patients aged ≥50 years as compared to younger ones (χ2 = 5,75; p = 0,02). More patients with radiotherapy in anamnesis had decreased BMD compared to patients who received chemotherapy only (χ2 = 8,82; p = 0,003) More than half of the patients (60 %) receiving regimens containing glucocorticosteroids had BMD decrease. Based on FRAX assessment, the 10‐year risk of major low‐energy fractures and the hip fractures was expectedly higher in patients with osteoporosis and osteopenia as compared to subjects with normal BMD (p < 0,05). A comparative analysis revealed that patients younger than 50 years old had more often lower values of BMD and Z‐score of the lumbar spine. In turn, the femoral neck was the most frequent localization of osteoporosis in patients older 50 years and postmenopausal women.Summary/Conclusion:The study demonstrates high prevalence of decreased BMD in patients with HL. The decrease in BMD is associated with radiotherapy and chemotherapy with glucocorticoids.