ASSESSMENT OF BONE MINERAL DENSITY IN PATIENTS WITH HODGKIN’S LYMPHOMA
Mariya Sergeevna VOYTKO1, Tatyana Ivanovna POSPELOVA1, Vadim Valerievich KLIMONTOV1,2, Olga Nikolaevna FAZULLINA2, Elena Viktorovna MEZIT1
1Novosibirsk State Medical University of Minzdrav of Russia
2Research Institute of Clinical and Experimental Lymphology - Branch of the Institute of Cytology and Genetics of SB RAS
Keywords: лимфома Ходжкина, минеральная плотность костной ткани, остеопороз, денситометрия, двухэнергетическая рентгеновская абсорбциометрия, Hodgkin’s lymphoma, bone mineral, osteoporosis, densitometry, dual-energy X-ray absorptiometry
Abstract
Currently, Hodgkin’s lymphoma (HL) is considered as a potentially curable disease. The polychemotherapy including various combinations of cytostatic drugs and glucocorticoids appears the standard of treatment in patients with HL. Patients with early stage disease (stage I to II) receive several cycles of chemotherapy followed by the radiotherapy. The possibility of achieving persistent disease-free survival poses a problem of ensuring a satisfactory quality of life and preventing the long-term consequences of antitumor therapy. One of those consequences may be a change in bone mineral density (BMD). Aim of the study was to assess the BMD in patients with HL. Material and methods. BMD was measured by dual-energy X-ray absorbtiometry using a stationary LunarProdigy bone densitometer (GE, USA). The Russian FRAX model was used in this study. The model uses clinical data to calculate the major low-energy fractures and the hip fractures. Results. The decreased BMD was revealed in 36 observed HL subjects (48.6 %). Patients with osteoporosis were generally older, had a lower body mass index as compared to patients with normal BMD ( p < 0.05). Based on FRAX assessment, the 10-year risk of major low-energy fractures and the hip fractures was expectedly higher in patients with osteoporosis and osteopenia as compared to subjects with normal BMD ( p < 0.05). More patients with radiotherapy in anamnesis had decreased BMD compared to patients who received chemotherapy only (χ2 = 5.47; р = 0.0194). More than half of the patients (59.1 %) receiving regimens containing glucocorticosteroids had BMD decrease. A comparative analysis revealed that patients younger than 50 years old had lower values of BMD and Z-score of the lumbar spine in the early stages of HL as compared to patients with stage III-IV. In turn, in patients older 50 years and postmenopausal women at the early stages of HL was a significant decrease of BMD and T-score of the femoral neck as compared to patients with advanced stages of the disease. This research suggests that the decrease in BMD in stages I-II of HL can be associated with radiotherapy as the generally accepted standard for the treatment of early stages of the disease.
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