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Quantitative Ultrasound of Proximal Phalanxes in Childhood Acute Lymphoblastic Leukemia Survivors

De Matteo, Antonia, MD*; Petruzziello, Fara, MD; Parasole, Rosanna, MD; Esposito, Antonella, MD; Mangione, Argia, MD; Giagnuolo, Giovanna, MD; Menna, Giuseppe, MD; Del Puente, Antonio, MD

Journal of Pediatric Hematology/Oncology: March 2019 - Volume 41 - Issue 2 - p 140–144
doi: 10.1097/MPH.0000000000001146
Clinical and Laboratory Observations

Reduced bone mineral density (BMD) is a well-known complication in childhood acute lymphoblastic leukemia (ALL) survivors; the optimal method to assess BMD is still debated. We studied BMD by quantitative ultrasound (QUS) in 72 ALL survivors, and evaluated any correlation with cumulative doses of steroids and cytotoxic agents. Mean age at diagnosis was 61±45 months, while mean age at QUS was 318.3±129.6 months; mean period of follow-up was 41.2±37.8 months. Mean amplitude-dependent speed of sound z-score was −1.22±1.19. Ten survivors (13.8%) presented a z-score below −2 SD. A negative correlation was found between amplitude-dependent speed of sound z-score and age at diagnosis (P=0.01). A positive correlation was observed with length of follow-up (P=0.01). No correlation was found with cytotoxic drugs. This study represents the largest cohort of childhood ALL survivors studied by QUS. Our results suggest that QUS for its characteristics of being radiation free may be an effective option to assess BMD in pediatric age. In addition, our data outline the importance to improve the awareness about the specific expression of this complication in the pediatric age, concerning the major determinants of bone impairment, which are the disease itself and the phase of bone growth when the disease occurs.

*Department of Translational Medical Science, Section of Pediatrics

Department of Pediatric Hemato-Oncology, Santobono-Pausilipon Hospital

Department of Clinical and Experimental Medicine, Rheumatology Unit, University “Federico II,” Naples, Italy

A.D.M. and F.P. contributed equally and share the first authorship.

A.D.M., F.P.: drafted the article. A.E., R.P., and A.D.P.: contributed to the design of the study, interpretation of data, and revising it critically for important intellectual content.

Partly presented at the 19th Congress of European Hematology Association, June 14–17, 2014, Milan, Italy.

The authors declare no conflict of interest.

Reprints: Rosanna Parasole, MD, Department of Pediatric Hemato-Oncology, Santobono-Pausilipon Hospital, Via Posillipo, 226, Naples 80123, Italy (e-mail:

Received May 28, 2017

Accepted January 5, 2018

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