Diabetes mellitus among adult survivors of childhood acute lymphoblastic leukemia: A report from the St. Jude Lifetime Cohort Study

Abstract

BACKGROUND: Greater than one-half of children who are treated for acute lymphoblastic leukemia (ALL) develop ≥1 treatment-related medical conditions in their lifetime, many of which are known risk factors for diabetes mellitus. In the current study, the authors evaluated the prevalence and risk factors of diabetes mellitus among clinically assessed adult survivors of childhood ALL METHODS: The authors performed a retrospective evaluation of data from survivors of ALL and community controls who were enrolled in the St. Jude Lifetime Cohort Study between October 1, 2007, and June 30, 2016. Participants were adults with ≥10 years of survival of childhood ALL and community controls who completed clinical and laboratory evaluations. Data for the current analysis were abstracted from medical records. Exposures evaluated herein included chemotherapy and radiation exposures and medical history, including drug-induced diabetes mellitus. RESULTS: Of 1360 eligible adults who were ≥10-year survivors of childhood ALL, a total of 1044 completed the evaluations; these individuals had a mean age of 33.97±9.14 years and 50.86% were male. The 368 controls, 45.65% of whom were male, had a mean age of 35.33±10.21 years. Type 2 diabetes mellitus (T2DM) was found in approximately 7.47% of survivors and 3.80% of controls (odds ratio [OR], 2.07; 95% CI, 1.11-3.87). In adjusted models, among survivors, older age (OR, 1.05 for each additional year; 95% CI, 1.02-1.08), body mass index ≥30 kg/m 2 (OR, 7.40; 95% CI,, and drug-induced diabetes mellitus occurring during ALL therapy (OR, 4.67; 95% CI, 2.53-8.61) were found to be associated with T2DM. CONCLUSIONS: Adult survivors of childhood ALL are at an increased risk of T2DM. Adult survivors of childhood ALL who are of older age, with an overweight or obese body mass index, and/or who developed drug-induced diabetes mellitus during treatment should be closely monitored for T2DM during long-term follow-up.

Racial and Economic Differences in the Risk of Hyperglycemia in Children Hospitalized With Acute Lymphoblastic Leukemia

“…However, the association for Hispanic children was attenuated with the addition of other contributing factors. Previous studies that included race as a predictor did not find differences in their samples (McCormick et al, 2020; Pui et al, 1981; Roberson et al, 2009; Sonabend et al, 2009; Williams et al, 2019).…”

“…Hyperglycemia is associated with diabetic ketoacidosis and increased risk for life-threatening infections in children receiving ALL treatment (Dare et al, 2013; McCormick et al, 2020; Roberson et al, 2008). Children who develop hyperglycemia during treatment may be at increased risk for type 2 diabetes mellitus as survivors (Williams et al, 2019).…”

Biomarkers of Glucose Metabolism Alterations and the Onset of Metabolic Syndrome in Survivors of Childhood Acute Lymphoblastic Leukemia

“…In this regard, special attention is paid to early detection of the components of metabolic syndrome that promote the development of lifestyle diseases. To successfully prevent possible complications, it is, however, necessary to understand the underlying mechanisms and their etiopathogenesis [ 8 , 17 ].…”

Body composition after allogeneic haematopoietic cell transplantation/total body irradiation in children and young people: a restricted systematic review

“…Metabolic syndrome is also reported in other survivors of childhood cancer, but HSCT, TBI and cranial or abdominal irradiation all appear to incur greater risk [13]. Recent studies also confirm an increased risk of type 2 diabetes in adult survivors of childhood leukaemia [14].…”