Degree of fatness after allogeneic BMT for childhood leukaemia or lymphoma

Nysom, Karsten; Holm, Kirsten; Michaelsen, Kim F.; Hertz, H; Jacobsen, N; Müller, Jørn; Mølgaard, Christian

doi:10.1038/sj.bmt.1703012

Cited by 27 publications

(29 citation statements)

References 31 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although cystatin C gives a more crude GFR estimate than does 51 Cr-EDTA analysis, it is probably more accurate than creatinine, as it is independent of muscle mass [14,15]. This may be particularly important in patients who have undergone SCT including TBI, as they often develop abnormalities in body composition with a proportionally reduced lean body mass [16]. We found chronic renal impairment (GFR<85 ml/min per 1.73 m 2 ) in two patients (11%), which is in line with the prevalence of impaired renal function reported by Kist-van Holthe et al [4], who in a prospective study found chronic renal impairment (in those > 2 years of age, this was defined as GFR<85 ml/min per 1.73 m 2 ) in four of 41 (10%) longterm survivors, 42% of whom had received TBI 5 years after allogeneic SCT.…”

Section: Glomerular Functionmentioning

confidence: 97%

Glomerular and tubular function in young adults treated with stem-cell transplantation in childhood

2010

View full text Add to dashboard Cite

We evaluated renal function at a median follow-up of 18 (range 10.3-22.1) years after total body irradiation in 18 patients treated with stem-cell transplantation (SCT) (autologous SCT in 15 and allogeneic SCT in three) for hematologic malignancies and compared them with 18 healthy controls. No patient had chronic graft-versus-host disease. We found no difference in glomerular filtration rate estimated from cystatin C (105 vs 111 ml/min/1.73 m(2), p = 0.28). Patients had higher albumin excretion (0.8 vs 0.4 mg/mmol, p = 0.001), but no patient had overt albuminuria (>200 mg/L). Patients had higher diastolic blood pressure (74 vs 67 mmHg, p = 0.003). Two patients (11%) had hypertension. Patients had lower tubular reabsorption of phosphate (0.78 vs 0.91 mmol/L, p = 0.014) and higher excretion of alpha-1-microglobulin (AMG/urine creatinine, 0.4 vs 0.25 mg/mmol, p = 0.038), which correlated with time after SCT (r = 0.6, p = 0.01). We found no difference in fractional excretion (FE) of other electrolytes, amino acid excretion, or urine osmolality. We conclude that renal function was relatively well preserved at a median follow-up of 18 years after childhood SCT. The higher albumin excretion in our patients is of concern, as is the association between excretion of AMG and time after SCT, suggesting that both glomerular and tubular function may deteriorate further.

show abstract

Section: Glomerular Functionmentioning

confidence: 97%

Glomerular and tubular function in young adults treated with stem-cell transplantation in childhood

2010

View full text Add to dashboard Cite

show abstract

“…28 Lower BMI were found by Nysom et al 32 in patients with childhood leukemia and lymphomas treated with TBI than in patients without TBI, which suggests that either TBI or more severe delayed side effects after HSCT alter body weight, and possibly body composition. Nyson et al 32 found that cranial irradiation leads to muscle loss and body fat in children. Couto-Silva et al 33 found that children with TBI had lower BMIs at 2 and 5 years post-HSCT than patients who were not treated with TBI.…”

Section: Effects Of Treatmentmentioning

confidence: 99%

Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

Kyle

Chalandon

Miralbell

et al. 2005

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Patients with hematological malignancies are well nourished prior to allogeneic hematopoietic stem cell transplantation (HSCT). HSCT and associated complications can affect body composition. The study evaluated crosssectionally the prevalence and longitudinally the changes in lean body mass index (LBMI) in HSCT patients. Patients (n ¼ 82) were classified as normal or low LBMI. Logistic regression analyses were used to estimate odds ratios (OR) for low vs normal LBMI, between healthy volunteers and patients; for limited or extensive vs no chronic graft-versus-host-disease (GVHD); and for decreased (Karnofsky o80) vs normal functional status (480). Patients were significantly more likely to have low LBMI at 6, 12 months, 2-3, 4-6 and 46 years than volunteers. In all, 38% of patients were below pre-HSCT LBMI at 4-6 years post-HSCT. Low LBMI was significantly associated with steroid treatment (OR 2.6, confidence intervals (CI) 1.3-5.2, P ¼ 0.008); limited (OR 5.5, CI 1.7-18.5, P ¼ 0.005) or extensive chronic GVHD (OR 20.3,, Po0.001); and decreased performance status (Karnofsky scores of p80) (OR 2.7, CI 1.3-5.9, P ¼ 0.01). Patients were more likely to have low LBMI than volunteers. Chronic GVHD and low performance status were associated with low LBMI; thus, complications and/or treatment increase the likelihood of low LBMI. Patients with hematological malignancies are usually well nourished at the time of allogeneic hematopoietic stem cell transplantation (HSCT). 1,2 However, nutritional consequences after HSCT have not been well studied. Underweight patients are at increased risk of death in the early post-HSCT period, and nonrelapse mortality is greater for extremely underweight or overweight patients. 3,4 High body mass index (BMI), weight normalized for height, may also affect treatment-related toxicity and mortality. 5 Furthermore, low lean body mass (LBM) has been associated with poor outcome and increased length of hospital stay. 6 Allogeneic HSCT and associated complications, including infections and graft-versus-host-disease (GVHD), can affect body weight and body composition. Immunosuppressive therapy after transplantation has been shown to alter skeletal muscle metabolism. 7 Corticosteroids promote muscle atrophy by increasing the rate of protein catabolism, amino-acid efflux, while simultaneously decreasing the rate of protein synthesis. 8 Thus, treatment and complications following HSCT exert profound negative effects on LBM.As low LBM is associated with poor outcome, the evaluation of LBM and body fat changes in pre-and post-HSCT patients can aid in adapting nutrition policy, for example, nutrition support in malnutrition and food restriction in obesity. 9 Just as BMI is useful in evaluating the excess or deficit in body weight in individuals of different heights, the lean body mass index (LBMI, kg/m 2 ) and body fat mass index (BFMI, kg/m 2 ) are potentially useful in evaluating body composition parameters by effectively eliminating differences in LBM and body fat with height. 10 Height-indepe...

show abstract

“…Although overweight/obesity in adult survivors of childhood ALL has been well evaluated, no longitudinal study that investigated metabolic abnormalities in survivors of childhood SCT has been reported, 15,16 and the mechanism of these conditions has not been completely understood. A longitudinal retrospective study of a cohort of adult survivors of childhood SCT was performed to determine whether adult survivors are at risk for overweight/obesity, metabolic abnormalities and fatty liver and whether this risk is associated with CRT or other factors used in the treatment of SCT.…”

Section: Introductionmentioning

confidence: 99%

High incidence of fatty liver and insulin resistance in long-term adult survivors of childhood SCT

Tomita

Ishiguro

Yasuda

et al. 2010

Bone Marrow Transplant

View full text Add to dashboard Cite

Overweight/obesity among adult survivors of childhood SCT has been considered to be predictive of eventual development of metabolic abnormalities. Fatty liver is increasingly recognized as a major cause of liver-related morbidity and mortality in the general population. However, the real incidence of fatty liver in adult survivors of SCT has not been fully elucidated. We determined whether adult survivors are at risk for overweight/obesity, metabolic abnormalities and fatty liver and whether these risks are associated with cranial radiotherapy (CRT) before SCT. Among the 51 patients (30 males), only two male patients were overweight/obese at the last evaluation. On the other hand, 9 male (30%) and 15 female (71%) patients were underweight. Fatty liver was diagnosed in 11 male (37%) and 10 female (48%) patients during the follow-up period, although patients who had fatty liver did not tend to be overweight/obese. Significantly more patients who received CRT before SCT developed fatty liver with insulin resistance than those who did not (Po0.05). Even patients who are not overweight/ obese may develop fatty liver and metabolic abnormalities. We recommend that healthcare professionals recognize these risks and give life-long attention to detecting, preventing and treating late complications after SCT.

show abstract

Degree of fatness after allogeneic BMT for childhood leukaemia or lymphoma

Cited by 27 publications

References 31 publications

Glomerular and tubular function in young adults treated with stem-cell transplantation in childhood

Glomerular and tubular function in young adults treated with stem-cell transplantation in childhood

Longitudinal follow-up of body composition in hematopoietic stem cell transplant patients

High incidence of fatty liver and insulin resistance in long-term adult survivors of childhood SCT

Contact Info

Product

Resources

About