Sarcopenia and preserved bone mineral density in paediatric survivors of high-risk neuroblastoma with growth failure

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Guo, Michelle
Zemel, Babette S.
Hawkes, Colin P.
Long, Jin
Kelly, Andrea
Leonard, Mary B.
Jaramillo, Diego
Mostoufi-Moab, Sogol
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John Wiley & Sons, Inc.
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Background: Survival from paediatric high-risk neuroblastoma (HR-NBL) has increased, but cis-retinoic acid (cis-RA), the cornerstone of HR-NBL therapy, can cause osteoporosis and premature physeal closure and is a potential threat to skeletal structure in HR-NBL survivors. Sarcopenia is associated with increased morbidity in survivors of paediatric malignancies. Low muscle mass may be associated with poor prognosis in HR-NBL patients but has not been studied in these survivors. The study objective was to assess bone density, body composition and muscle strength in HR-NBL survivors compared with controls. Methods: This prospective cross-sectional study assessed areal bone mineral density (aBMD) of the whole body, lumbar spine, total hip, femoral neck, distal 1/3 and ultradistal radius and body composition (muscle and fat mass) using dual-energy X-ray absorptiometry (DXA) and lower leg muscle strength using a dynamometer. Measures expressed as sex-specific standard deviation scores (Z-scores) included aBMD (adjusted for height Z-score), bone mineral apparent density (BMAD), leg lean mass (adjusted for leg length), whole-body fat mass index (FMI) and ankle dorsiflexion peak torque adjusted for leg length (strength-Z). Muscle-specific force was assessed as strength relative to leg lean mass. Outcomes were compared between HR-NBL survivors and controls using Student's t-test or Mann–Whitney U test. Linear regression models examined correlations between DXA and dynamometer outcomes. Results: We enrolled 20 survivors of HR-NBL treated with cis-RA [13 male; mean age: 12.4 ± 1.6 years; median (range) age at therapy initiation: 2.6 (0.3–9.1) years] and 20 age-, sex- and race-matched controls. Height-Z was significantly lower in HR-NBL survivors compared with controls (−1.73 ± 1.38 vs. 0.34 ± 1.12, P < 0.001). Areal BMD-Z, BMAD-Z, FMI-Z, visceral adipose tissue and subcutaneous adipose tissue were not significantly different in HR-NBL survivors compared with controls. Compared with controls, HR-NBL survivors had lower leg lean mass-Z (−1.46 ± 1.35 vs. − 0.17 ± 0.84, P < 0.001) and strength-Z (−1.13 ± 0.86 vs. − 0.15 ± 0.71, P < 0.001). Muscle-specific force was lower in HR-NBL survivors compared with controls (P < 0.05). Conclusions: Bone mineral density and adiposity are not severely impacted in HR-NBL survivors with growth failure, but significant sarcopenia persists years after treatment. Future studies are needed to determine if sarcopenia improves with muscle-specific interventions in this population of cancer survivors.
High-risk neuroblastoma , DXA , Sarcopenia , Areal bone mineral density , Autologous stem cell transplantation , Cis-retinoicacid
Guo, M., Zemel, B. S., Hawkes, C. P., Long, J., Kelly, A., Leonard, M. B., Jaramillo, D. and Mostoufi-Moab, S.(2021) 'Sarcopenia and preserved bone mineral density in paediatric survivors of high-risk neuroblastoma with growth failure', Journal of Cachexia, Sarcopenia and Muscle, 12(4), pp. 1024-1033. doi: 10.1002/jcsm.12734
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