title: R-CHOP(-like) treatment of diffuse large B-cell lymphoma significantly reduces CT-assessed vertebral bone density: a single center study of 111 patients.
abstract: Treatment of diffuse large B-cell lymphoma (DLBCL) with R-CHOP(-like) regimens include large cumulative doses of prednisolone. In this retrospective study, we evaluated changes in vertebral bone density (VD) in DLBCL patients by measuring CT-ascertained Hounsfield units (HU) at the L3 level. In total, 111 patients diagnosed from 2007 to 2012 and response assessed following first line treatment were included. Post-treatment VD was significantly reduced to 86% of pretreatment VD on average (p < .001). Neither female sex nor high age (>70 years) were significantly associated with greater post-treatment VD reduction. Two years after completing R-CHOP treatment, VD remained significantly lower than baseline VD (p < .001). Vertebral compression fractures visualized by CT were found in 16/111 patients (14%) during follow-up. In conclusion, bone mineral density is significantly reduced following R-CHOP(-like) treatment and vertebral compression fractures are common. Glucocorticoid-induced osteoporosis may therefore have impact on survivorship for the large fraction of DLBCL patients with durable remissions.
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Svendsen
authors.affiliation: b Department of Radiology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Nitesh
authors.initials: N
authors.lastname: Shekhrajka
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.|c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Kasper Lindblad
authors.initials: KL
authors.lastname: Nielsen
authors.affiliation: c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.|d Department of Endocrinology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Mette Østergaard
authors.initials: MØ
authors.lastname: Poulsen
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.|e Department of Oncology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Anders Krog
authors.initials: AK
authors.lastname: Vistisen
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Peter Svenssen
authors.initials: PS
authors.lastname: Munksgaard
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Marianne Tang
authors.initials: MT
authors.lastname: Severinsen
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Paw
authors.initials: P
authors.lastname: Jensen
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.|c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Johnsen
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.|c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Lasse Hjort
authors.initials: LH
authors.lastname: Jakobsen
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.|c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Bøgsted
authors.affiliation: b Department of Radiology , Aalborg University Hospital , Aalborg , Denmark.|c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Jens Brøndum
authors.initials: JB
authors.lastname: Frøkjær
authors.affiliation: a Department of Hematology , Aalborg University Hospital , Aalborg , Denmark.|c Department of Clinical Medicine , Aalborg University Hospital , Aalborg , Denmark.
authors.forename: Tarec Christoffer
authors.initials: TC
authors.lastname: El-Galaly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D015519:Bone Density / Q000187:drug effects*; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D000072078:Positron Emission Tomography Computed Tomography; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D011379:Prognosis; D000069283:Rituximab; D013131:Spine / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015415:Biomarkers; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Diffuse large B-cell lymphoma; Hounsfield units; R-CHOP; bone mineral density; computed tomography