Bone Remodeling Markers in Children with Acute Lymphoblastic Leukemia after Intensive Chemotherapy: The Screenshot of a Biochemical Signature

Purpose: to investigate the effects of intensive chemotherapy and glucocorticoid (GC)treatment on bone remodeling markers in children with acute lymphoblastic leukemia (ALL). Methods:A cross-sectional study was carried out in 39 ALL children (aged 7.64 4.47) and 49 controls(aged 8.7 4.7 years). Osteoprotegerin (OPG), receptor activator of NF-B ligand (RANKL), osteocalcin(OC), C-terminal telopeptide of type I collagen (CTX), bone alkaline phosphatase (bALP),tartrate-resistant acid phosphatase 5b (TRACP5b), procollagen type I N-terminal propeptide (P1NP),Dickkopf-1 (DKK-1), and sclerostin were assessed. Statistical analysis was conducted using theprincipal component analysis (PCA) to study patterns of associations in bone markers. Results:ALL patients showed significantly higher OPG, RANKL, OC, CTX, and TRACP5b than the controls(p 0.02). Considering ALL group, we found a strong positive correlation among OC, TRACP5b,P1NP, CTX, and PTH (r = 0.43-0.69; p < 0.001); between CTX and P1NP (r = 0.5; p = 0.001); andbetween P1NP and TRAcP (r = 0.63; p < 0.001). The PCA revealed OC, CTX, and P1NP as the mainmarkers explaining the variability of the ALL cohort. Conclusions: Children with ALL showed asignature of bone resorption. The assessment of bone biomarkers could help identify ALL individualswho are most at risk of developing bone damage and who need preventive interventions.