Predictors Vertebral Deformity In Long-Term Survivors Of Childhood Acute Lymphoblastic Leukemia: The Petale Study.
The prevalence of vertebral deformities in long-term survivors of childhood ALL is unknown. Our objectives were to identify the prevalence of vertebral deformities and their risk factors among long-term childhood ALL survivors.We recruited 245 (49% male) long-term childhood ALL survivors from the PETALE Cohort (French-Canadian ALL survivors treated between the years 1987 and 2010 with the Dana Farber Cancer Institute clinical trials protocols, who did not experience disease relapse and/or receive hematopoietic stem cell transplant). Median age at recruitment was 21.7y (range 8.5-41y) and median time since diagnosis was 15.1y (range 5.4-28.2y). All participants underwent spine radiograph and dual-energy X-ray absorptiometry scans. The prevalence of vertebral deformity was 23% with 88% classified as grade 1 according to the Genant method. The majority of vertebral deformities were clinically silent. Regression analysis confirmed male gender (RR = 1.94, 95%CI: 1.16 – 3.24, p = 0.011), higher glucocorticoid cumulative dose (RR = 1.05, 95% CI:1.00 – 1.10, p = 0.032) and back pain (RR = 2.44, 95%CI: 1.56 – 3.84, p<0.001) as predictors of prevalent vertebral deformity. Gender differences in vertebral deformity predictors emerged.We report a significant prevalence of vertebral deformities in this young cohort. Male gender, cumulative glucocorticoid dose and back pain were identified as predictors of prevalent vertebral deformity. Back pain emerging as a strong predictor of vertebral deformity underscores the importance of ongoing bone health surveillance in survivors with persistent vertebral deformities treated with these earlier protocols.