Significant bone loss in children receiving chemotherapy for acute lymphoblastic leukemia (ALL) occurs during the first month of treatment, much earlier than previously assumed, according to research presented in the journal Bone.1

Only 1 in 5 children with ALL survived the disease 40 years ago. But advances in chemotherapy improved survival rates, and now more than 90% of patients are cured. However, patients experience significant side effects including loss of bone density resulting in higher risk for bone fractures during and after therapy.

Previous studies focused on the cumulative effects of chemotherapy after months or years of treatment. But investigators at Children’s Hospital Los Angeles (CHLA) saw many patients in clinic with fractures and vertebral compression during the early weeks of treatment and sought to assess when chemotherapy-related bone loss began in children with ALL.

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The CHLA investigators used quantitative computerized tomography (QCT) to assess patients 10 to 21 years old with newly diagnosed ALL for leukemia-related changes to bone at diagnosis, and the subsequent effects of induction chemotherapy. QCT is a more accurate technique for assessing growing bone.

Compared with similar age- and sex-matched control patients, the investigators determined that the leukemia did not dramatically alter characteristics of patients’ bone.

However, bone mineral density of the lower spine decreased by more than 25% with significant thinning of the dense cortex in the bones of the leg during the 30-day induction phase of chemotherapy.

“Now that we know how soon bone toxicity occurs, we need to re-evaluate our approaches to managing these changes and focus research efforts on new ways to mitigate this common—yet significant—adverse effect,” said Steven Mittleman, MD, PhD, principal investigator at The Saban Research Institute of CHLA and senior author on the study.


1. Children’s Hospital Los Angeles. Bone loss associated with leukemia therapy occurs sooner than previously thought [news release]. EurekAlert! Web site. Posted February 4, 2016. Accessed February 5, 2016.