title: Vitamin D and Bone Minerals Status in the Long-term Survivors of Childhood Acute Lymphoblastic Leukemia.
abstract: BACKGROUND
  Low vitamin D and diminished bone minerals with the potential for fractures are one of the nonapparent late effects of acute lymphoblastic leukemia (ALL). Chemotherapy and radiation were known as two important risk factors. We evaluated these late effects in ALL survivors who were treated with chemotherapy or chemo plus cranial radiation therapy.
  
  
  METHODS
  In a case-control study, 33 of ALL survivors who were treated with chemotherapy (Group A), and 33 subjects who were treated with chemoplus cranial radiation (Group B) were compared against 33 matched age, sex, and pubertal stage of their healthy siblings (Group C). Standard anthropometric data were collected as well as Tanner staging for puberty, number of fractures since treatment, serum calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D (25(OH) D). The independent t-test, one-way ANOVA, Chi-square test, and Tukey's test were used to analyze the data.
  
  
  RESULTS
  The findings indicated that the mean serum levels of 25(OH) D in ALL survivors (i.e. Groups A and B) with age mean score of 11.2 years and 12.3 years, average treatment length: 3.25 years and average time after treatment completion: 4 years, was lower compared to the controls group (12.94 ± 6.69, 14.6 ± 8.1, 20.16 ± 10.83, respectively, P < 0.001) but no significant difference was observed between Group A and B in this regard (P > 0.05). Other clinical and laboratory parameters had no significant differences between the survivors and control. Vitamin D deficiency (<20 ng/ml) was observed in 27% of group A and 24% of group B and vitamin D insufficiency (20-30 ng/ml) in 72.7% and 69.6% survivors of Group A and B and 48.5% of controls group (P = 0.003).
  
  
  CONCLUSIONS
  ALL treatment is associated with the increase in prevalence of vitamin D insufficiency in the childhood ALL survivors and since the low vitamin D level potentially increases the risk of low bone density, subsequent malignancies, and cardiovascular disease in the survivors, close follow-up of such patients are highly recommended to prevent the stated complications.
authors.affiliation: Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Nahid
authors.initials: N
authors.lastname: Reisi
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Parisa
authors.initials: P
authors.lastname: Iravani
authors.affiliation: Department of Health Services Research, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Pouran
authors.initials: P
authors.lastname: Raeissi
authors.affiliation: Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
keywords: Acute lymphoblastic leukemia; bone minerals; long-term survivors; vitamin D insufficiency