الفهرس 
Acute Lymphoblastic LeukemiaOnly 14 pages are availabe for public view
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Abstract
cute lymphoblastic leukemia (ALL) is a heterogeneous disease characterized by the accumulation and proliferation of clonal lymphoid progenitor cells in the bone marrow , periphery and / or extramedullary sites (Michael et al., 2012). As a consequence there is accumulation of an immature B- or T- cell clone in the bone marrow resulting in the suppression of normal hematopoiesis and in various extramedullary sites .80-85% of ALL are of B-cell lineage (B-cell precursor ALL “BCP-ALL”), and 15-20% are of T-cell lineage (T-ALL) (Graux, 2011).
Bone health and the loss of bone density are impor-tant clinical concerns for patients with cancer who may be at risk for primary osteoporosis because of aging and other risk factors. They may have the added risk for cancer treatment-induced bone loss (CTIBL), which also could be termed secondary osteoporosis related to therapy and cancer (Rita, 2011).
Risk factors for the development of skeletal complications in ALL include poor nutrition, reduced mobility, impaired bone mineralization, older age at diagnosis and being of male gender.
-Bone pain is one of the initial symptoms in childhood ALLs that may result from direct leukemic infiltration of the periosteum, bone infarction, or expansion of the marrow cavity by leukemic cells. In normal hematopoiesis, hematopoietic stem cells (HSCs) are in balance with components of the hematopoietic microenvironment including osteoblastic cells, osteoclasts, mesenchymal cells, and vascular structures. In leukemia, invasion of leukemia cells results in osteopenia mediated by an expansion of osteoclasts causing increased bone resorption and a concomitant reduction of osteoblastic activity (Lane, 2012).
A decrease in bone mineral density (BMD) is a common consequence of treatments for cancers in children and adolescents (Jae et al., 2013).
Bone mineral density (BMD) is a good index for evaluating bone status and diagnosis of metabolic bone disorders. Osteoporosis and osteopenia are the most prevalent metabolic bone diseases that are characterized by low BMD (Gozashti, 2011).
DEXA is generally considered the “gold standard” method of measuring BMD for diagnosing osteoporosis and monitoring the effects of osteoporosis therapy (Gralow et al., 2011).
Normal bone mass is defined by the World Health Organization as a bone mass density (BMD) within one standard deviation (SD) of the mean for young adults, osteopenia as increased bone loss with a bone mass between 1 and 2.5 SDs below normal, and osteoporosis as a bone mass >2.5 SDs below normal (Hendra et al.,2014).
Twenty-five (25) adult patients with newly diagnosed acute lymphoblastic leukemia enrolled in our study. The patients were diagnosed by complete blood count with blood film, bone marrow aspiration and flow cytometry for immunophenotypic classification. sixteen patients (64%) were Pre-B ALL, one patient (4%) were Pro-B ALL, two patients (8%) were mature B ALL and six patients (24%) were T ALL. Conventional karyotyping study offered to all patients for cytogenetic stratification, all of them had normal karyotyping except one patient had complex chromosomal abnormalities. FISH analysis of translocation t(9;22) )(q34;q11) revealed the presence of three patients with Ph chromosome positive and twenty two patients had negative Ph chromosome.
Few studies examined the relationship between ALL and Bone mineral density (BMD) specifically in adult patients. Therefore, the aim of this work was to study the relationship between ALL and bone miniral density in adult patients.
We evaluated the Bone mineral density (BMD) in all the studied subjects at presentation and after induction chemotherapy for the surviving patients, followed by studying the statistical differences between Left Femur Bone Density before and after treatment , lumbar spine Bone Density before and after treatment and patients subgroups in relation to the different clinical and prognostic variables in ALL.
We detected that There was no patient could be defined as having osteoporosis. There were seven (28%) patient who fulfilled theWHOcriteria for osteopenia in the lumbar spine at diagnosis, but after treatment the number of osteopenic patients increase to ten (40%) patients as regard lumbar spine. But Left Femoral Neck as regards mean BMD,T score and Z score, was normal in all patients before and after treatment.
Bone Density (BMD,T score, Z score) in femoral neck was correlated to clinical variables (age, sex, CT scan LN/HSM, CSF infiltration and Ph chromosome) at diagnosis and at follow up. However, we did not find any statistically significant correlation between them.
Also,We observed that there is no significant correlation between Lumbar spine Bone Density (BMD,T score, Z score) at diagnosis and at follow up and any of these prognostic factors.
Left femoral neck bone denisity(BMD, T score, Z score)were negatively correlated with (TLC,Blast %,LDH,Uric acid,G GT,Absolute blast count) in ALL patients.
we detected the presence of a statistically significant and positive correlation between Ca and Lumber spine Bone Density (BMD) after treatment. However, we did not find any statistically significant correlation between femoral neck bone density and calcium.
Also, we detected the presence of a statistically high significant and negative correlation between platelet and Lumber spine Bone Density (BMD) after treatment.
These results indicated that ALL itself and its treatment influence bone health and lead to loss of bone density