Skeletal, neuromuscular and fitness impairments among children with newly diagnosed acute lymphoblastic leukemia

Kirsten K Ness, Sue C Kaste, Liang Zhu, Ching-Hon Pui, Sima Jeha, Paul C Nathan, Hiroto Inaba, Karen Wasilewski-Masker, Durga Shah, Robert J Wells, Robyn E Karlage, Leslie L Robison, Cheryl L Cox, Kirsten K Ness, Sue C Kaste, Liang Zhu, Ching-Hon Pui, Sima Jeha, Paul C Nathan, Hiroto Inaba, Karen Wasilewski-Masker, Durga Shah, Robert J Wells, Robyn E Karlage, Leslie L Robison, Cheryl L Cox

Abstract

This study describes skeletal, neuromuscular and fitness impairments among 109 children (median age 10 [range 4-18] years, 65.1% male, 63.3% white) with acute lymphoblastic leukemia (ALL). Outcomes were measured 7-10 days after diagnosis and compared to age- and sex-specific expected values. Associations between function and health-related quality of life (HRQL) were evaluated with logistic regression. Children with ALL had sub-optimal bone mineral density (BMD) Z-score/height (mean ± standard error: - 0.53 ± 0.16 vs. 0.00 ± 0.14, p < 0.01), body mass index percentile (57.6 ± 3.15 vs. 50.0 ± 3.27%, p = 0.02), quadriceps strength (201.9 ± 8.3 vs. 236.1 ± 5.4 N, p < 0.01), 6 min walk distance (385.0 ± 13.1 vs. 628.2 ± 7.1 m, p < 0.001) and Bruininks-Oseretsky Test of Motor Proficiency scores (23 ± 2.5 vs. 50 ± 3.4%, p < 0.01). Quadriceps weakness was associated with a 20.9-fold (95% confidence interval 2.5-173.3) increase in poor physical HRQL. Children with newly diagnosed ALL have weakness and poor endurance and may benefit from early rehabilitation that includes strengthening and aerobic conditioning.

Trial registration: ClinicalTrials.gov NCT00902213.

Keywords: Acute lymphoblastic leukemia; muscle strength; pediatric; physical endurance; quality of life.

Figures

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Consort diagram

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