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Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received

1
Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel
2
Department of Radiology, Rambam Health Care Campus, Haifa 3109601, Israel
3
Quality Assurance Unit, Rambam Health Care Campus, Haifa 3109601, Israel
4
Department of Nuclear Medicine, Rambam Health Care Campus, Haifa 3109601, Israel
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Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa 3109601, Israel
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Blood Bank and Apheresis Unit, Rambam Health Care Campus, Haifa 3109601, Israel
*
Author to whom correspondence should be addressed.
These authors contributed equally to the study.
Academic Editor: Elisabetta Abruzzese
Cancers 2022, 14(3), 495; https://doi.org/10.3390/cancers14030495
Received: 23 December 2021 / Revised: 10 January 2022 / Accepted: 16 January 2022 / Published: 19 January 2022
(This article belongs to the Section Cancer Therapy)
Hodgkin lymphoma (HL) is considered a largely curable disease (~80%). The young patient age at diagnosis and their long life expectancy make quality-of-life issues, including osteopenia, exceedingly important. This study aimed to assess treatment-related bone mineral density (BMD) changes that are overlooked in this young population. BMD was measured using PET/CT scans. Among 213 patients (median age 29 years), post-treatment BMD reduction of >15% was significantly more common in those aged ≥30 years and was also associated with a cumulative dose of steroids used. At 6 months post-therapy, BMD recovery was observed in ABVD (adriamycin/bleomycin/vinblastine/dacarbazine) treated patients, while individuals receiving EB (bleomycin/etoposide/adriamycin/cyclophosphamide/oncovin/procarbazine/prednisone) regimens demonstrated persistent BMD loss and higher rates of osteopenia. Our findings suggest that steroid use should be minimized and highly gonadotoxic drugs like procarbazine should be substituted with less toxic ones, due to their deleterious effect on BMD. Adequate vitamin D levels should be maintained.
Nowadays, Hodgkin lymphoma (HL) has become highly curable. The young age at diagnosis and long life expectancy emphasize the importance of preventing long-term treatment side effects, including bone mineral density (BMD) loss, in these patients. We aimed to evaluate the effects of first-line therapeutic modalities on BMD dynamics in HL patients, intending to identify individuals at risk for osteopenia. Demographics, HL risk factors, treatment, including cumulative steroid doses, and BMD of 213 newly-diagnosed HL patients (median age 29 years), treated at Rambam between 2008–2016, were analyzed. The main chemotherapy regimens applied were: ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (EB; bleomycin, etoposide, adriamycin, cyclophosphamide, oncovin, procarbazine, prednisone). BMD was measured using PET/CT scans. BMD loss >15% was revealed in 48% of patients at therapy completion, with osteopenia prevalence of 4% and 14% at baseline and post-therapy, respectively. Cumulative hydrocortisone equivalent doses >3400 mg/m2 correlated with significant BMD reduction. Multivariate analysis at 6 months post-therapy identified age ≥30 years and EB-regimens as significant risk factors for BMD decrease >15%. Therapy-related BMD loss is common in HL patients. Its persistence is associated with age ≥30 years and EB treatment. Reduction of cumulative steroid doses and switch to non-gonadotoxic drugs should be considered. View Full-Text
Keywords: Hodgkin lymphoma; bone mineral density; osteopenia; chemotherapy regimens; steroids; gonadotoxicity; PET/CT Hodgkin lymphoma; bone mineral density; osteopenia; chemotherapy regimens; steroids; gonadotoxicity; PET/CT
MDPI and ACS Style

Ofshenko, N.; Bercovich, E.; Mashiach, T.; Weiler-Sagie, M.; Militianu, D.; Dann, E.J. Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received. Cancers 2022, 14, 495. https://doi.org/10.3390/cancers14030495

AMA Style

Ofshenko N, Bercovich E, Mashiach T, Weiler-Sagie M, Militianu D, Dann EJ. Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received. Cancers. 2022; 14(3):495. https://doi.org/10.3390/cancers14030495

Chicago/Turabian Style

Ofshenko, Nadav, Eyal Bercovich, Tania Mashiach, Michal Weiler-Sagie, Daniela Militianu, and Eldad J. Dann. 2022. "Reduction of the Vertebral Bone Mineral Density in Patients with Hodgkin Lymphoma Correlates with Their Age and the Treatment Regimen They Received" Cancers 14, no. 3: 495. https://doi.org/10.3390/cancers14030495

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