title: Increased cardiometabolic traits in pediatric survivors of acute lymphoblastic leukemia treated with total body irradiation.
abstract: Survivors of childhood acute lymphoblastic leukemia (ALL) may face an increased risk of metabolic and cardiovascular late effects. To determine the prevalence of and risk factors for adverse cardiometabolic traits in a contemporary cohort of pediatric ALL survivors, we recruited 48 off-therapy patients in remission treated with conventional chemotherapy and 26 treated with total body irradiation (TBI)-based hematopoietic cell transplantation (HCT) in this cross-sectional pilot study. At a median age of 15 years (range, 8-21 years), HCT survivors were significantly more likely than non-HCT survivors to manifest multiple cardiometabolic traits, including central adiposity, hypertension, insulin resistance, and dyslipidemia. Overall, 23.1% of HCT survivors met the criteria for metabolic syndrome (≥ 3 traits), compared with 4.2% of non-HCT survivors (P = .02). HCT survivors also had increased C-reactive protein and leptin levels and decreased adiponectin, suggestive of underlying inflammation and increased visceral fat. In multivariate analyses, history of HCT remained associated with ≥ 2 traits (odds ratio [OR]. 5.13; 95% confidence interval [CI], 1.54-17.15) as well as with ≥ 3 traits (OR, 16.72; 95% CI, 1.66-168.80). Other risk factors included any cranial radiation exposure and family history of cardiometabolic disease. In summary, pediatric ALL survivors exposed to TBI-based HCT as well as to any cranial radiation may manifest cardiometabolic traits at an early age and should be screened accordingly.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. ericchow@u.washington.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chow
authors.forename: Jill H
authors.initials: JH
authors.lastname: Simmons
authors.forename: Christian L
authors.initials: CL
authors.lastname: Roth
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hoffmeister
authors.forename: Jean E
authors.initials: JE
authors.lastname: Sanders
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000378:metabolism*; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D024821:Metabolic Syndrome / Q000209:etiology / Q000378:metabolism; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000378:metabolism* / Q000628:therapy*; D011446:Prospective Studies; D012307:Risk Factors; D017741:Survivors; D014916:Whole-Body Irradiation / Q000009:adverse effects; D055815:Young Adult
chemical_list: D020738:Leptin; D002097:C-Reactive Protein