الفهرس 
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Abstract
Leukemia is a group of blood cancers that usually begin in the bone marrow and result in high numbers of abnormal blood cells. These blood cells are not fully developed and are called blasts or leukemia cells. Damage to the bone marrow, by way of displacing the normal bone marrow cells with higher numbers of immature white blood cells, results in a lack of blood platelets, which are important in the blood clotting process and red blood cells results in anemia. Diagnosis is typically made by blood tests or bone marrow aspiration. Acute lymphoblastic leukemia (ALL) is the most common malignant disorder in childhood. Since the survival is improved due to modern combined chemotherapy protocols today, long-term complications increase as a result of intensive therapy. Despite advances in management, the backbone of therapy remains multi-agent chemotherapy with vincristine, corticosteroids and an anthracycline with allogeneic stem cell transplantation for eligible candidates. Osteopenia and osteoporosis are important but unnoticed problems that might appear due to disease itself and chemotherapeutical agents, most likely corticosteroids, methotrexate, and cranial radiotherapy. Dietary problems and decreased physical activity are additional factors that influence bone health. Since a reduced BMD predisposes to osteopenia and osteoporosis, specific attention and therapeutic interventions should be considered. The aim of our study was to evaluate bone density by DXA scan in children and adolescent with Acute Lymphoblastic leukemia at diagnosis and after 6 m of treatment with chemotherapy The current study was included 50 children and adolescents; 25 children and Adolescents with Acute Lymphoblastic Leukemia at time of diagnosis (group I) and 25 children with leukemia after 6 months treatment of chemotherapy (group II). The mean age of this study children was 7.92+ 3.59 years in group I and 8.42+ 3.59 years in group II. The two groups were matched as regards weight, Height and BMI. In the present study Bone Mass Density was significantly lower in the leukemia children after 6 months treatment of chemotherapy (0.53±0.11), compared to leukemia children at time of diagnosis (0.59±0.11) (P<0.05). Also, bone mineral content and Z score were significantly lower in group II patients (20.5±7.82 and 2.1120±0.676, respectively), compared to group I (23.13±9.18 and 82.25±85.2, respectively). In the current study Z score (Lumbar spine) of all group I children and Adolescents with ALL at time of diagnosis was in normal range (>-1). While 56% of group II children had normal Z score (Lumbar spine) range, 40% had Osteopenia (-1 to-2) and 4% had osteonecrosis (< -2). In this study children with leukemia after 6 months treatment of chemotherapy had significantly lower Total leucocyte count (2.1120±0.676), compared to children and adolescents with Acute Lymphoblastic Leukemia at time of diagnosis (82.25±85.2). There was no significant difference between 2 groups included in this regarding hemoglobin, platelet, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and Red cell distribution width - coefficient of variation. There was no significant difference according to (liver function) Serum Glutamic Pyruvic Transaminase, serum glutamicoxaloacetic in the patient Groups (II) compared to group (I). There was no significant difference according to (Kidney function) Uric acid and creatinine in the patient Groups (II) compared to group (I). In the present study the mean alkaline phosphatase and Phosphorus level in children with leukemia after 6 months treatment of chemotherapy was significantly lower, compared to Children with leukemia at time of diagnosis. There was significant correlation between BMD with age, BMC, and SGOT. Moreover, there was significant correlation between Z score with all Variable and age, BMC, sex and BMD. In conclusion bone Mass Density, bone mineral content and Z score are significantly lowered after chemotherapy of ALL patients. Since a reduced BMD predisposes to osteopenia and osteoporosis, the use of DXA scanning to evaluate and monitor BMD in children with ALL may be useful to identify those patients at risk for developing osteopenia, osteoporosis, and pathological fractures.