1
|
O'Toole TE, Amraotkar AA, DeFilippis AP, Rai SN, Keith RJ, Baba SP, Lorkiewicz P, Crandell CE, Pariser GL, Wingard CJ, Pope Iii CA, Bhatnagar A. Protocol to assess the efficacy of carnosine supplementation in mitigating the adverse cardiovascular responses to particulate matter (PM) exposure: the Nucleophilic Defense Against PM Toxicity (NEAT) trial. BMJ Open 2020; 10:e039118. [PMID: 33372072 PMCID: PMC7772308 DOI: 10.1136/bmjopen-2020-039118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Exposure to airborne particulate matter (PM) is associated with cardiovascular disease. These outcomes are believed to originate from pulmonary oxidative stress and the systemic delivery of oxidised biomolecules (eg, aldehydes) generated in the lungs. Carnosine is an endogenous di-peptide (β-alanine-L-histidine) which promotes physiological homeostasis in part by conjugating to and neutralising toxic aldehydes. We hypothesise that an increase of endogenous carnosine by dietary supplementation would mitigate the adverse cardiovascular outcomes associated with PM exposure in humans. METHODS AND ANALYSIS To test this, we designed the Nucleophilic Defense Against PM Toxicity trial. This trial will enroll 240 participants over 2 years and determine if carnosine supplementation mitigates the adverse effects of PM inhalation. The participants will have low levels of endogenous carnosine to facilitate identification of supplementation-specific outcomes. At enrollment, we will measure several indices of inflammation, preclinical cardiovascular disease and physical function. Participants will be randomly allocated to carnosine or placebo groups and instructed to take their oral supplement for 12 weeks with two return clinical visits and repeated assessments during times of peak PM exposure (June-September) in Louisville, Kentucky, USA. Statistical modelling approaches will be used to assess the efficacy of carnosine supplementation in mitigating adverse outcomes. ETHICS AND DISSEMINATION This study protocol has been approved by the Institutional Review Board at the University of Louisville. Results from this study will be disseminated at scientific conferences and in peer-reviewed publications.Trial registration: NCT03314987; Pre-results.
Collapse
Affiliation(s)
- Timothy E O'Toole
- Division of Environmental Medicine, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, USA
| | - Alok A Amraotkar
- Division of Environmental Medicine, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, USA
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | - Shesh N Rai
- Department of Biostatistics and Bioinfomatics, University of Louisville, Louisville, Kentucky, USA
| | - Rachel J Keith
- Division of Environmental Medicine, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, USA
| | - Shahid P Baba
- Division of Environmental Medicine, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, USA
| | - Pawel Lorkiewicz
- Division of Environmental Medicine, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, USA
- Department of Chemistry, University of Louisville, Louisville, KY, USA
| | - Catherine E Crandell
- Department of Physical Therapy, Bellarmine University, Louisville, Kentucky, USA
| | - Gina L Pariser
- Department of Physical Therapy, Bellarmine University, Louisville, Kentucky, USA
| | | | - C Arden Pope Iii
- Department of Economics, Brigham Young University, Provo, Utah, USA
| | - Aruni Bhatnagar
- Division of Environmental Medicine, Christina Lee Brown Envirome Institute, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
2
|
Quantitative Ultrasound of Proximal Phalanxes in Childhood Acute Lymphoblastic Leukemia Survivors. J Pediatr Hematol Oncol 2019; 41:140-144. [PMID: 29620678 DOI: 10.1097/mph.0000000000001146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reduced bone mineral density (BMD) is a well-known complication in childhood acute lymphoblastic leukemia (ALL) survivors; the optimal method to assess BMD is still debated. We studied BMD by quantitative ultrasound (QUS) in 72 ALL survivors, and evaluated any correlation with cumulative doses of steroids and cytotoxic agents. Mean age at diagnosis was 61±45 months, while mean age at QUS was 318.3±129.6 months; mean period of follow-up was 41.2±37.8 months. Mean amplitude-dependent speed of sound z-score was -1.22±1.19. Ten survivors (13.8%) presented a z-score below -2 SD. A negative correlation was found between amplitude-dependent speed of sound z-score and age at diagnosis (P=0.01). A positive correlation was observed with length of follow-up (P=0.01). No correlation was found with cytotoxic drugs. This study represents the largest cohort of childhood ALL survivors studied by QUS. Our results suggest that QUS for its characteristics of being radiation free may be an effective option to assess BMD in pediatric age. In addition, our data outline the importance to improve the awareness about the specific expression of this complication in the pediatric age, concerning the major determinants of bone impairment, which are the disease itself and the phase of bone growth when the disease occurs.
Collapse
|
3
|
Preliminary Evidence of an Association Between ADHD Medications and Diminished Bone Health in Children and Adolescents. J Pediatr Orthop 2017; 37:348-354. [PMID: 26398435 DOI: 10.1097/bpo.0000000000000651] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The US Centers for Disease Control and Prevention estimate that 3.5 million children use psychotropic drugs for attention-deficit hyperactivity disorder (ADHD). With an increase in use of these types of drugs, thorough understanding of their potential side effects on the growing skeleton is needed. The purpose of this study was to determine whether there is an association between use of ADHD medication and diminished bone health. METHODS Three waves of the National Health and Nutrition Examination Survey public-use data set, collected from 2005 through 2010, were compiled for this study (N=5315). Bone health was measured using dual-energy x-ray absorptiometry scans, which were performed for participants aged 8 to 17 years to determine bone mineral density (BMD) for 3 regions: (1) total femur; (2) femoral neck; and (3) lumbar. Use of ADHD medications was determined by self-reported responses to questions regarding prescription drug use, which were answered by either the respondent or the respondent's parent or guardian. Multiple statistical techniques were used to produce estimates of association between ADHD medication use and z score age and sex standardized BMD measures, including survey adjusted univariate, survey adjusted multiple linear regression, and generalized estimating equations with a propensity-matched subsample (N=1967). Multivariate models adjusted for covariates including time period, age, sex, race/ethnicity, family income to poverty ratio, and total number of prescription medications. RESULTS Conservative estimates of the difference in standardized BMD measures between the ADHD medication group and the nonmedicated group range from -0.4855 (±0.27; P<0.001) for total femoral, -0.4671 (±0.27; P<0.001) for femoral neck, and -0.3947 (±0.29; P<0.01) for lumbar. Significantly more children on ADHD medications versus match subjects on no medication had BMDs with in osteopenic range (38.3% vs. 21.6%, P<0.01). DISCUSSION The findings suggest that there are real and nontrivial differences in BMD for children and adolescents taking ADHD medications, as compared with similar children not taking any prescription medications. Prescribing physicians and parents should be aware of potential bone health risks associated with these medications. LEVEL OF EVIDENCE Level III-case-control study.
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Childhood cancer survivors experience excessive weight gain early in treatment. Lifestyle interventions need to be initiated early in cancer care to prevent the early onset of obesity and cardiovascular disease (CVD). We reviewed the existing literature on early lifestyle interventions in childhood cancer survivors and consider implications for clinical care. RECENT FINDINGS Few lifestyle interventions focus on improving nutrition in childhood cancer survivors. A consistent effect on reducing obesity and CVD risk factors is not evident from the limited number of studies with heterogeneous intervention characteristics, although interventions with a longer duration and follow-up show more promising trends. Future lifestyle interventions should be of a longer duration and include a nutrition component. Interventions with a longer duration and follow-up are needed to assess the timing and sustainability of the intervention effect. Lifestyle interventions introduced early in cancer care are both safe and feasible.
Collapse
Affiliation(s)
- Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
| | - Michael J Kelly
- Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA
- Division of Pediatric Hematology and Oncology, The Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| |
Collapse
|
5
|
The Association of Oral Vitamin D and Calcium Supplementation With Bone Mineral Density in Pediatric Acute Lymphoblastic Leukemia Patients. J Pediatr Hematol Oncol 2017; 39:287-292. [PMID: 28234736 DOI: 10.1097/mph.0000000000000797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To investigate the association of calcium (Ca) and vitamin D (vit D) supplementation with bone mineral density (BMD) in pediatric acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS Group I (n=11): de novo ALL patients aged 1 to 18 years. Group II (n=46): pediatric ALL survivors in first complete remission and ALL patients on maintenance chemotherapy. We stratified group II into 3 subgroups according to the postdiagnosis period (group IIa: 8 to 24 mo, group IIb: 24 to 48 mo, group IIc: >48 mo). Group III (n=22): healthy siblings of group II. Daily oral vit D3 and Ca carbonate was given only to group I. In group I, BMD was measured at diagnosis and after completion of intensive chemotherapy (TP1 and TP2). RESULTS A significant increase in Ca (P=0.024) and 25-OH vit D (P=0.01), and a decrease in magnesium (P=0.023) were detected at TP2 compared with TP1 in group I. Mean plasma levels of 25-OH vit D were <20 ng/mL in all the groups. Total body (P=0.005), total body less head (P=0.005), and L1 to L4 BMD Z scores (P=0.025) decreased significantly at TP2 compared with TP1. The lowest BMD scores were found at 8 to 24 months after diagnosis in unsupplemented patients. A gradual increase in BMD Z scores was shown, with the highest scores in group IIc. CONCLUSION Vit D and Ca supplementation in pediatric ALL patients during intensive chemotherapy may not prevent bone mineral loss. BMD scores of pediatric ALL patients described by other studies, as a major decrease in the first 2 years and gradual increase afterward, was also observed in our patients.
Collapse
|
6
|
Abstract
BACKGROUND Childhood cancer survivors are at a higher risk of developing health conditions such as osteoporosis, and cardiovascular disease than their peers. Health-promoting behaviour, such as consuming a healthy diet, could lessen the impact of these chronic issues, yet the prevalence rate of health-protecting behaviour amongst survivors of childhood cancer is similar to that of the general population. Targeted nutritional interventions may prevent or reduce the incidence of these chronic diseases. OBJECTIVES The primary aim of this review was to assess the efficacy of a range of nutritional interventions designed to improve the nutritional intake of childhood cancer survivors, as compared to a control group of childhood cancer survivors who did not receive the intervention. Secondary objectives were to assess metabolic and cardiovascular risk factors, measures of weight and body fat distribution, behavioural change, changes in knowledge regarding disease risk and nutritional intake, participants' views of the intervention, measures of health status and quality of life, measures of harm associated with the process or outcomes of the intervention, and cost-effectiveness of the intervention SEARCH METHODS We searched the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL; 2013, Issue 3), MEDLINE/PubMed (from 1945 to April 2013), and Embase/Ovid (from 1980 to April 2013). We ran the search again in August 2015; we have not yet fully assessed these results, but we have identified one ongoing trial. We conducted additional searching of ongoing trial registers - the International Standard Randomised Controlled Trial Number register and the National Institutes of Health register (both screened in the first half of 2013) - reference lists of relevant articles and reviews, and conference proceedings of the International Society for Paediatric Oncology and the International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer (both 2008 to 2012). SELECTION CRITERIA We included all randomised controlled trials (RCTs) that compared the effects of a nutritional intervention with a control group which did not receive the intervention in this review. Participants were childhood cancer survivors of any age, diagnosed with any type of cancer when less than 18 years of age. Participating childhood cancer survivors had completed their treatment with curative intent prior to the intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected and extracted data from each identified study, using a standardised form. We assessed the validity of each identified study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. We used the GRADE criteria to assess the quality of each trial. MAIN RESULTS Three RCTs were eligible for review. A total of 616 participants were included in the analysis. One study included participants who had been treated for acute lymphoblastic leukaemia (ALL) (275 participants). Two studies included participants who had all forms of paediatric malignancies (266 and 75 participants). All participants were less than 21 years of age at study entry. The follow-up ranged from one month to 36 months from the initial assessment. All intended outcomes were not evaluated by each included study. All studies looked at different interventions, and so we were unable to pool results. We could not rule out the presence of bias in any of the studies.There was no clear evidence of a difference in calcium intake at one month between those who received the single, half-day, group-based education that focused on bone health, and those who received standard care (mean difference (MD) 111.60, 95% confidence interval (CI) -258.97 to 482.17; P = 0.56, low quality evidence). A regression analysis, adjusting for baseline calcium intake and changes in knowledge and self-efficacy, showed a significantly greater calcium intake for the intervention as compared with the control group at the one-month follow-up (beta coefficient 4.92, 95% CI 0.33 to 9.52; P = 0.04). There was statistically significant higher, self-reported milk consumption (MD 0.43, 95% CI 0.07 to 0.79; P = 0.02, low quality evidence), number of days on calcium supplementation (MD 11.42, 95% CI 7.11 to 15.73; P < 0.00001, low quality evidence), and use of any calcium supplementation (risk ratio (RR) 3.35, 95% CI 1.86 to 6.04; P < 0.0001, low quality evidence), with those who received this single, face-to-face, group-based, health behaviour session.There was no clear evidence of a difference in bone density Z-scores measured with a dual-energy X-ray absorptiometry (DEXA) scan at 36 months follow-up (MD -0.05, 95% CI -0.26 to 0.16; P = 0.64, moderate quality evidence) between those who received calcium and vitamin D supplementation combined with nutrition education and those who received nutrition education alone. There was also no clear evidence of a difference in bone mineral density between the intervention and the control group at the 12-month (median difference -0.17, P = 0.99) and 24-month follow-up (median difference -0.04, P = 0.54).A single multi-component health behaviour change intervention, focusing on general healthy eating principles, with two telephone follow-ups brought about a 0.17 lower score on the four-point Likert scale of self-reported junk food intake compared with the control group (MD -0.17, 95% CI -0.33 to -0.01; P = 0.04, low quality evidence); this result was statistically significant. There was no clear evidence of a difference between the groups in the self-reported use of nutrition as a health protective behaviour (MD -0.05, 95% CI -0.24 to 0.14; P = 0.60, low quality evidence). AUTHORS' CONCLUSIONS Due to a paucity of studies, and the heterogeneity of the studies included in this review, we are unable to draw conclusions regarding the effectiveness of nutritional interventions for use with childhood cancer survivors. Although there is low quality evidence for the improvement in health behaviours using health behaviour change interventions, there remains no evidence as to whether this translates into an improvement in dietary intake. There was also no evidence that the studies reduced the risk of cardiovascular and metabolic disorders in childhood cancer survivors, although no evidence of effect is not the same as evidence of no effect. This review highlights the need for further well designed trials to be implemented in this population.
Collapse
Affiliation(s)
- Jennifer E Cohen
- Kids Cancer Centre, Sydney Children’s HospitalDepartment of Nutrition and DieteticsRandwick NSWAustralia
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- University of WollongongSchool of MedicineWollongongNSWAustralia
| | - Claire E Wakefield
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- Kids Cancer Centre, Sydney Children's HospitalRandwick NSWAustralia
| | - Richard J Cohn
- School of Women’s and Children’s HealthDiscipline of PaediatricsRandwick NSWAustralia
- Kids Cancer Centre, Sydney Children's HospitalRandwick NSWAustralia
| | | |
Collapse
|
7
|
Cancer and bone: A complex complex. Arch Biochem Biophys 2014; 561:159-66. [DOI: 10.1016/j.abb.2014.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 12/13/2022]
|
8
|
Watsky MA, Carbone LD, An Q, Cheng C, Lovorn EA, Hudson MM, Pui CH, Kaste SC. Bone turnover in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2014; 61:1451-6. [PMID: 24648266 PMCID: PMC4625912 DOI: 10.1002/pbc.25025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/12/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND We investigated the effects of demographic, lifestyle (self-reported smoking status and physical activity levels), cancer-related treatment factors (radiation and chemotherapy), and diet (calcium and vitamin D intake) on bone turnover and the relationship of bone turnover to lumbar spine bone mineral density (BMD) Z-scores (LS-BMD Z-scores) determined by quantitative computed tomography (QCT) in 418 ≥5-year survivors of childhood acute lymphoblastic leukemia (ALL). PROCEDURE Bone turnover was assessed by biomarkers including serum bone-specific alkaline phosphatase (BALP), osteocalcin (OC), and urinary N-telopeptide of type I collagen indexed to creatinine (NTX/Cr). The 215 males ranged in age from 9 to 36 years (median age 17 years). RESULTS Age and tanner score were inversely associated with all biomarkers (BALP, OC, NTX/Cr) (P < 0.001). Males had higher BALP and OC than females (P < 0.001). Body mass index (BMI) was inversely associated with OC and NTX/Cr (P < 0.001). There was no significant association of biomarkers with lifestyle related factors, ALL treatment-related factors, dietary calcium, vitamin D, or LS-BMD Z-score. CONCLUSIONS In this population of long-term survivors of ALL, bone turnover was significantly associated with age, gender, tanner stage, and BMI. ALL-related treatments did not influence bone turnover and bone turnover was not predictive of volumetric LS-BMD Z-score.
Collapse
Affiliation(s)
| | - Laura D. Carbone
- Department of Medicine, Georgia Regents University, Augusta, Ga, USA
| | - Qi An
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Cheng Cheng
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Elizabeth A. Lovorn
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Melissa M. Hudson
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sue C. Kaste
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
9
|
Kaste S, An Q, Smith K, Surprise H, Lovorn E, Boyett J, Ferry R, Relling M, Shurtleff S, Pui C, Carbone L, Hudson M, Ness K. Calcium and cholecalciferol supplementation provides no added benefit to nutritional counseling to improve bone mineral density in survivors of childhood acute lymphoblastic leukemia (ALL). Pediatr Blood Cancer 2014; 61:885-93. [PMID: 24395288 PMCID: PMC4160024 DOI: 10.1002/pbc.24882] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/04/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND We sought to improve lumbar spine bone mineral density (LS-BMD) in long-term survivors of childhood acute lymphoblastic leukemia (ALL) using calcium and cholecalciferol supplementation. PROCEDURE This double-blind, placebo-controlled trial randomized 275 participants (median age, 17 [9-36.1] years) with age- and gender-specific LS-BMD Z-scores <0 to receive nutritional counseling with supplementation of 1,000 mg/day calcium and 800 International Unit cholecalciferol or placebo for 2 years. The primary outcome was change in LS-BMD assessed by quantitative computerized tomography (QCT) at 24 months. Linear regression models were employed to identify the baseline risk factors for low LS-BMD and to compare LS-BMD outcomes. RESULTS Pre-randomization LS-BMD below the mean was associated with male gender (P = 0.0024), White race (P = 0.0003), lower body mass index (P < 0.0001), and cumulative glucocorticoid doses of ≥ 5,000 mg (P = 0.0012). One hundred eighty-eight (68%) participants completed the study; 77% adhered to the intervention. Mean LS-BMD change did not differ between survivors randomized to supplements (0.33 ± 0.57) or placebo (0.28 ± 0.56). Participants aged 9-13 years and those 22-35 years had the greatest mean increases in LS-BMD (0.50 ± 0.66 and 0.37 ± 0.23, respectively). Vitamin D insufficiency (serum 25[OH]D <30 ng/ml) found in 296 (75%), was not associated with LS-BMD outcomes (P = 0.78). CONCLUSION Cholecalciferol and calcium supplementation provides no added benefit to nutritional counseling for improving LS-BMD among adolescent and young adult survivors of ALL (93% of whom had LS-BMD Z-scores above the mean at study entry).
Collapse
Affiliation(s)
- S.C. Kaste
- St. Jude Children’s Research Hospital, Memphis, TN,University of Tennessee Health Science Center, Memphis, TN,Corresponding author: Dr. Sue C. Kaste, Department of Radiological Sciences 262 Danny Thomas Place, MSN #220 Memphis, TN 38105 Phone: 901-595-3347 Fax: 901-595-3981
| | - Q. An
- St. Jude Children’s Research Hospital, Memphis, TN
| | - K. Smith
- St. Jude Children’s Research Hospital, Memphis, TN
| | - H. Surprise
- St. Jude Children’s Research Hospital, Memphis, TN
| | - E. Lovorn
- St. Jude Children’s Research Hospital, Memphis, TN
| | - J. Boyett
- St. Jude Children’s Research Hospital, Memphis, TN
| | - R.J. Ferry
- University of Tennessee Health Science Center, Memphis, TN,Le Bonheur Children’s Hospital, Memphis, TN
| | - M.V. Relling
- St. Jude Children’s Research Hospital, Memphis, TN
| | | | - C.H. Pui
- St. Jude Children’s Research Hospital, Memphis, TN
| | - L. Carbone
- University of Tennessee Health Science Center, Memphis, TN
| | - M.M. Hudson
- St. Jude Children’s Research Hospital, Memphis, TN
| | - K.K. Ness
- St. Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
10
|
The outcome of allogeneic hematopoietic stem cell transplants without total body irradiation in pediatric patients with acute lymphoblastic leukemia: single centre experience. J Pediatr Hematol Oncol 2012; 34:101-7. [PMID: 22367385 DOI: 10.1097/mph.0b013e31824435a1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The most widely accepted conditioning regimen to allogeneic hematopoietic stem cell transplantation consists of total body irradiation, especially in patients affected by acute lymphoblastic leukemia (ALL). In this retrospective study, we report our experience on hematopoietic stem cell transplantation in 44 pediatric patients with acute lymphoblastic leukemia using a non-radiation-based conditioning regimen (busulfan/cyclophosphamide). Median age at transplantation was 12.5 years (range, 4 to 14 y). 39 out of 44 patients received transplants in complete remission. At a median follow-up of 390 days, the probabilities of 3-year disease-free survival and overall survival were 50% and 68%, respectively. Disease status of hematopoietic stem cell transplantation was the only significant variable affecting the overall survival. Acute and chronic graft-versus-host disease occurred in 23 (64%) and 12(18%) patients, respectively. Relapse was significantly higher among patients transplanted in advanced disease status. The results of the study indicate that non-radiation-based preparative regimens can be used in pediatric patients with ALL. However, well-designed comparative trials are needed to better clarify the difference between radiation and non-radiation-based conditioning regimens in pediatric ALL.
Collapse
|
11
|
El-Hajj Fuleihan G, Muwakkit S, Arabi A, Daouk LEO, Ghalayini T, Chaiban J, Abboud M. Predictors of bone loss in childhood hematologic malignancies: a prospective study. Osteoporos Int 2012; 23:665-74. [PMID: 21476039 DOI: 10.1007/s00198-011-1605-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
SUMMARY Twenty-nine children with malignancies and age, gender-matched controls were prospectively studied over 14 months. Patients had higher parathyroid hormone (PTH) levels and fat mass, lower bone mass, and bone mass increments at follow-up than controls. Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses. INTRODUCTION Children with hematologic malignances have low bone mass. We prospectively investigated anthropometric, clinical, and hormonal predictors of changes in bone mass in children receiving cancer therapy. METHODS Twenty-nine children, mean age of 9 ± 2.9 years and 32 age and gender-matched controls, were studied. Seven had completed their course 40 ± 22 weeks prior, while 22 were still receiving therapy for 80 ± 28 weeks. Age at diagnosis, calcium intake, exercise activity, systemic corticosteroids in dexamethasone (Dex) dose, and methotrexate (MTX), and intrathecal MTX therapy received within follow-up period were assessed. Routine chemistries, PTH, 25-hydroxy vitamin D (25-OHD), bone remodeling markers, bone mass, and body composition were measured at baseline and 14 months. RESULTS Patients had lower exercise activity, sun exposure, and bone markers levels than controls. They had higher PTH levels and fat mass, lower bone mass at the spine, hip, and total body, and lower increments at these sites on follow-up. Predictors of bone mass changes on univariate analyses were: age at diagnosis (R = -0.50 to -0.44, p < 0.05), Dex-MTX doses (R = -0.58 to -0.41, p < 0.05), intrathecal therapy (p < 0.03),% changes in lean mass (R = 0.37 to 0.54, p < 0.04), 25-OHD levels (R = 0.39, p < 0.03), and PTH levels (R = -0.47 to -0.41, p < 0.05). Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses. CONCLUSION This study provides insight into the pathophysiology of bone loss in children receiving cancer therapy and possible interventions to optimize their skeletal health.
Collapse
Affiliation(s)
- Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, Division of Endocrinology, Department of Internal Medicine, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020 Beirut, Lebanon.
| | | | | | | | | | | | | |
Collapse
|
12
|
Tylavsky FA, Smith K, Surprise H, Garland S, Yan X, McCammon E, Hudson MM, Pui CH, Kaste SC. Nutritional intake of long-term survivors of childhood acute lymphoblastic leukemia: evidence for bone health interventional opportunities. Pediatr Blood Cancer 2010; 55:1362-9. [PMID: 20981691 PMCID: PMC3586793 DOI: 10.1002/pbc.22737] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (ALL) are vulnerable to exaggeration of the aging process including decreased bone mineral density (BMD). As little is known about their dietary or nutrient intake that may affect their long-term bone health, we examined nutrient intake in long-term survivors of childhood ALL. PROCEDURE Survivors (n = 164) of childhood ALL who had completed treatment for at least 5 years and were in continuous remission, completed a 110-item food questionnaire that reflected dietary intake over the previous year. The analyzed cohort comprised 34 females and 38 males younger than 19 years and 45 females and 47 males at least 19 years. Reported nutrient intake and food selection were compared with age-specific Recommended Dietary Allowance and USDA Pyramid Food Guide. Body mass index was compared to the general US population, adjusted for age, gender, Tanner stage and race. RESULTS Less than 30% of participants met recommended dietary intakes for vitamin D, calcium, potassium, or magnesium regardless of age. Mean daily caloric intake was 2,204 kcal (51% from carbohydrates) for younger and 2,160 kcal (49% from carbohydrates) for older participants. Energy intake from sweets was 70% higher than recommended. Participants < 19 years were less likely to have a healthy weight (odds ratio 0.48, 95% CI 0.30-0.79); > 19 years more likely to be overweight (odds ratio 1.95, 95% CI 1.11-3.32, P < 0.002). CONCLUSIONS Survivors of childhood ALL need careful dietary intervention to optimize long-term health.
Collapse
Affiliation(s)
- Frances A. Tylavsky
- Department of Preventive Medicine, University of Tennessee, Health Science Center, Memphis, TN, USA
| | - Karen Smith
- Department of Nutritional Services, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Harriet Surprise
- Department of Nutritional Services, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sarah Garland
- Department of Biostatistics, University of Memphis, Memphis, TN, USA
| | - Xiaowei Yan
- Department of Biostatistics, University of Memphis, Memphis, TN, USA
| | - Elizabeth McCammon
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pediatrics, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pediatrics, College of Medicine, University of Tennessee, Health Science Center, Memphis, TN, USA
| | - Sue C. Kaste
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Radiology, University of Tennessee, Health Science Center, Memphis, TN, USA
| |
Collapse
|
13
|
Ruble K, Hayat MJ, Stewart KJ, Chen AR. Bone mineral density after bone marrow transplantation in childhood: measurement and associations. Biol Blood Marrow Transplant 2010; 16:1451-7. [PMID: 20417715 DOI: 10.1016/j.bbmt.2010.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 04/14/2010] [Indexed: 12/12/2022]
Abstract
UNLABELLED This study examined the bone mineral density (BMD) of 46 (median age 16.3, 8-29) survivors of autologous and allogeneic bone marrow transplantation (BMT). Areal (g/m2) BMD was acquired with dual energy x-ray absorptiometry and volumetric (g/cm3) BMD values were calculated. Abnormal BMD was identified in 24% (11/46) of survivors with areal measures and 22% (10/46) with volumetric measures. Comparison of areal and volumetric BMD revealed the measures were highly correlated (r = 0.73, p<0.001) but clinical diagnosis of osteopenia/osteoporosis were not consistent. Volumetric z-scores were higher for 7/8 of the survivors who were < 3rd percentile for height. Associations of BMD and body composition and disease and treatment factors were assessed with multiple linear regression. When controlling for other significant associations and cumulative steroid dose, the body composition measure of fat mass index (FMI) was associated with higher volumetric BMD z-scores (CI: 0.006, 0.193; p = 0.037). CNS irradiation (CI: -1.710,-0.200; p = 0.015), age at time of testing (CI: -0.116, -0.024; p = 0.004) and female sex (CI: -1.375, -0.155; p = 0.015) were associated with lower volumetric BMD z-scores. CONCLUSIONS Childhood BMT survivors are at risk for diminished BMD. Areal and volumetric DEXA derived measures of BMD are highly correlated and volumetric measures may correct for underestimation of BMD in BMT survivors who are small for age. Survivors who received CNS irradiation, are older and female may be at greater risk for diminished BMD while fat mass is associated with higher BMD in childhood BMT survivors.
Collapse
Affiliation(s)
- Kathy Ruble
- Department of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | | | | |
Collapse
|
14
|
Wesa KM, Cassileth BR. Is there a role for complementary therapy in the management of leukemia? Expert Rev Anticancer Ther 2009; 9:1241-9. [PMID: 19761428 DOI: 10.1586/era.09.100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with leukemia often seek additional treatments not prescribed by their oncologist in an effort to improve their cancer treatment outcome or to manage symptoms. Complementary therapies are used in conjunction with traditional cancer treatments to decrease symptoms and side effects associated with cancer or cancer treatment, and to improve patients' overall quality of life. Complementary therapies are distinct from so-called 'alternative' therapies, which are unproven, ineffective and may postpone or interfere with mainstream cancer treatment. Complementary therapies are pleasant, inexpensive, nonpharmacologic and effective. For patients with leukemia, the complementary therapies that are always appropriate include mind-body interventions, such as self-hypnosis, meditation, guided imagery and breath awareness. Massage and reflexology (foot massage) decrease symptoms with effects lasting at least 2 days following treatment. Acupuncture is very beneficial for symptom management without adverse consequences. Physical fitness with regular exercise and healthy dietary habits can significantly decrease side effects of cancer treatments and may prolong survival. Botanical extracts and vitamin supplements may interfere with active cancer treatments, and should be discussed with the oncologist or pharmacist before use.
Collapse
Affiliation(s)
- Kathleen M Wesa
- Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, NY 10021, USA.
| | | |
Collapse
|