Bone metabolism, growth rate and pubertal development in children with chronic myeloid leukemia treated with imatinib during puberty

Fiorina Giona, Stefania Mariani, Lucio Gnessi, Maria Luisa Moleti, Massimiliano Rea, Annalisa De Vellis, Deborah Marzella, Anna Maria Testi, and Robin Foa'

Haematologica 2012, DOI: 10.3324/haematol.2012.067447 4

...An altered bone and mineral metabolism, a reduction of testosterone and gynecomastia referred to PDGF-R and c-KIT inhibition in normal cells have been reported in adults treated with IM.2-4 So far, most of the data on the long-term side-effects of IM in children who have received IM concerns its impact on growth.5-7. We hereby report 4 CML pre-pubertal patients (3 males and 1 female; median age at the beginning of the IM, 10.6 years) in complete cytogenetic response (CCyR) with IM who were regularly monitored, between May 2004 and June 2011, to evaluate the bone and mineral metabolism, as well as growth and pubertal development. [...] In conclusion, the side effects observed in our patients (deceleration of longitudinal growth, reduction of BMD and fertility) raise some concerns that children long-exposed to IM prior to puberty may behave differently from adults. Since the number of children on treatment with TKIs is constantly increasing, DEXA, CTX, growth velocity in all patients, and FSH and inhibin-B in all males should be regularly monitored to plan the optimal treatment strategy in this category of patients.