Skeletal abnormalities detected by SPECT is associated with increased relapse risk in pediatric acute lymphoblastic leukemia

Is there a risk of early relapse in patients with acute lymphoblastic leukemia presenting with bone-associated symptoms?

Background/Aim: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood. Patients usually present with fatigue, pallor, weight loss, and joint and/or bone findings. However, the effects of bone-associated symptoms on prognosis remains controversial. We aimed to demonstrate whether bone-associated symptoms affect prognosis in children with ALL. Methods: This retrospective cohort study included the data from 268 patients with ALL who were diagnosed and treated between January 2011 and December 2020. The patients were divided into two groups as those with and without bone-associated symptoms. We compared the groups in terms of age, gender, immunophenotyping, day 8 prednisolone response, and risk groups, in addition to minimal residual disease (MRD), relapse, and survival rates. Results: Eighty-five out of 268 (32%) children had bone-associated symptoms at the time of diagnosis, whereas others (n=183) had none of these symptoms. The relapse rate in children with bone-associated symptoms was found to be higher than the others (17.6% versus 12%), but the difference was not significant (P=0.24). However, children with bone findings developed earlier relapse when compared with the others (18.6 versus 28.6 months; P<0.001). Conclusion: Therefore, we suggest that bone-associated symptoms at the time of diagnosis could be considered a warning sign for earlier relapse, and these children should be carefully followed.

Physical Fitness of School-Age Children after Cancer Treatment

The aim of the study was to assess physical fitness of school-age children after cancer treatment. The study was comprised of one hundred and fifty six children-children after cancer treatment (n = 71, mean age 11.22 ± 3.11 years) vs. healthy children previously untreated for cancer (n = 85, mean age 10.71 ± 1.22 years). Physical fitness was assessed indirectly based on a ball throw (assessment of strength, coordination, and upper limb speed), long jump (assessment of jumping ability, speed, and coordination), and a 60 m run (assessment of speed). The analysis was performed based on the Student's t-test for independent samples and the analysis of variance and the post-hoc least significant difference test (LSD test). Children from the study group threw the ball closer and had shorter long jump performance compared to the control group, i.e., 12.93 [m] vs. 19.79 [m], respectively (p < 0.001) and 2.46 [m] vs. 2.70 [m], respectively (p = 0.02). However, their mean running time was longer, i.e., 13.33 [s] vs. 11.73 [s], respectively (p = 0.01). Division according to sex showed additionally significantly shorter ball throw distance in the study group in both girls (p = 0.001) and boys (p < 0.001), significantly shorter jump length in the group of girls (p = 0.01), and significantly longer running time in the group of boys (p = 0.04). Children treated for cancer are characterized by decreased physical fitness, and motor ability is sex-dependent. Both groups showed decreased strength, coordination, and upper limb speed. Additionally, worse jumping ability was found in girls whereas decreased speed was observed in boys.

Physical training interventions for children and teenagers affected by acute lymphoblastic leukemia and related treatment impairments

A decreased physical fitness has been reported in patients and survivors of acute lymphoblastic leukemia (ALL). This is influenced by the negative effects of the disease and by the treatments of childhood cancer.

In the past, children were advised to recover in bed, and to take as much relax as possible. Nowadays, it is considered that too much immobility may result in a further decrease of physical fitness and functioning. Exercise training for ALL children has frequently been reported to improve physical fitness and the well-being of the children, since it prevents the negative effects of a sedentary life-style, such as obesity and a poor skeletal health. In recent years, different studies and protocols on this subject has become available for children and young adults with cancer, both during and after treatment.

The efficacy of recent physical exercise training interventions, that act on several ALL impairments in children such as skeletal, musculoskeletal, neuromuscular, cardiopulmonary and cardiovascular systems, fatigue, body balance disorders and metabolism alterations have been examined.

These side effects might be prevented or significantly reduced by introducing a physical exercise program during or shortly after cancer treatment. Several interventions are discussed and presented for each impairment, reducing their level caused by the disease and thus suggesting the importance of physical training activity in ameliorating the children quality of life.