Cardiovascular risk, cardiac function, physical activity, and quality of life with and without long-term growth hormone therapy in adult survivors of childhood acute lymphoblastic leukemia.
BACKGROUND
Long-term data are missing in GH-treated acute lymphoblastic leukemia (ALL) patients. GH therapy may result in poorer outcome regarding cardiovascular (CV) and particularly cardiac effects than in patients with hypothalamic-pituitary disease.


OBJECTIVE
Our objective was to evaluate GH therapy on CV risk, cardiac function, physical activity, and quality of life in ALL patients treated with cranial radiotherapy (18-24 Gy) and chemotherapy (anthracycline dose 120 mg/m2).


METHODS
We conducted a 5- and 8-yr open nonrandomized prospective study in a university hospital clinic.


METHODS
Two groups of GH-deficient ALL patients (aged 25 yr; range 19-32 yr) and matched population controls participated.


METHODS
One ALL group (n=16) received GH for 5 yr, and the other ALL group (n=13) did not receive GH therapy.


METHODS
We evaluated the prevalence of CV risk factors and metabolic syndrome (International Diabetes Federation consensus), cardiac function (echocardiography), and quality of life and physical activity questionnaires.


RESULTS
In comparison with 8 yr without, 5 yr with GH therapy resulted in significant positive changes in plasma glucose (-0.5 vs. 0.6 mmol/liter, P=0.002), apolipoprotein B/apolipoprotein A1 ratio (-0.1 vs. 0.0, P=0.03), and high-density lipoprotein-cholesterol (0.20 vs.-0.01 mmol/liter, P=0.008) and a significant reduction in the prevalence of metabolic syndrome (P=0.008). No significant difference in the left-ventricular systolic function or in physical activity and quality of life was recorded before and after 5 or 8 yr, respectively (all P>0.3).


CONCLUSIONS
GH therapy reduced the CV risk in this young ALL population but resulted in no clear benefit or deterioration in cardiac function.
Follin
Cecilia
C
Department of Endocrinology, Lund and Malmö University Hospital, Lund University, SE-221 85 Lund, Sweden.
Thilén
Ulf
U
Osterberg
Kai
K
Björk
Jonas
J
Erfurth
Eva Marie
EM
D000328:Adult; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology; D002648:Child; D005260:Female; D006334:Heart Function Tests; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009043:Motor Activity; D018579:Patient Selection; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012306:Risk; D012307:Risk Factors; D012944:Social Support; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D017741:Survivors
D019382:Human Growth Hormone