Therapy-Related Risk Factors of Mandel et al for Decreased Bone Mineral Density in Pediatric Acute Lymphoblastic Leukemia (ALL)

 

Most children with ALL who survive recover normal bone mineral density.

 

Risk factors for decrease bone mineral density (BMD):

(1) total methotrexate dose > 40,000 mg per square meter BSA

(2) total corticosteroid dose > 9,000 mg per square meter BSA

 

where:

• In the implementation I used the Dubois and Dubois formula for determining body surface area. This may not be the best algorithm for small children. I also assumed that the relevant body surface area was that at the time of therapy.

• To keep the algorithm simple I did not incorporate potency of different steroid preparations.

 

A patient with childhood ALL who meets one or both criteria should be monitored for osteoporosis. The authors monitored bone mineral density in the femoral neck.