Lipid Complications after Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

Abstract

HSCT (hematopoietic stem cell transplantation) is a widely applied method of treatment of pediatric patients with leukemia and other bone marrow-associated disorders. Metabolic disturbances can appear as procedure side effects. This study aimed to report incidence of lipid and thyroid disorders and time of their onset in pediatric patients after HSCT. There were 198 pediatric patients (123 males) aged 0.5–20 years who were subjected to HSCT. Patients were mostly diagnosed with Acute Leukemia (n = 190). The analysis of lipids, thyroid hormones, and thyroid antibodies levels comprised one month before the HSCT to last follow up visit between 2016 and 2019 (median 3.8 ± 1.8 years after HSCT). In males, the triglycerides levels increased over two times in the course of HSCT in both patients with initially low and elevated HDL (high-density lipoprotein) levels. Most of the lipid disorders occurred in six months after HSCT. Patients treated with L-thyroxine exhibited decreased LDL (low-density lipoprotein) levels. HDL remained at a lower level in males. Thyroid hormone abnormalities were evenly distributed in time until 4 years after HSCT. Patients require long term follow up including lipid metabolism and thyroid function analysis. HSCT survivors demand introduction of polyunsaturated fatty acids into the diet to reduce risk of developing the lipid complications.

The Expression of Genes Related to Lipid Metabolism and Metabolic Disorders in Children before and after Hematopoietic Stem Cell Transplantation—A Prospective Observational Study

“…Hematopoietic stem cell transplantation (HSCT) is a procedure performed to treat various disorders, including hematopoietic malignancies, selected solid tumors, primary immunodeficiencies, and inborn errors of metabolism [ 1 , 2 , 3 ]. The range of its clinical applications continues to expand, particularly in children, leading to increased long-term survival associated with improved treatment of short-term complications [ 2 , 3 , 4 , 5 ].…”

“…In most of cases, it involves high-dose chemotherapy or total-body irradiation with supralethal fractionated doses, causing bone marrow ablation [ 7 ]. Intensity of the treatment regimen, as well as toxicity of chemotherapeutic agents used during conditioning and immunosuppressive drugs (particularly cyclosporine (CsA) and glucocorticoids (GCs)), have significant impact on the general condition of patients and development of metabolic disorders, both by direct pharmacological effects and nutritional disturbances [ 1 , 8 ].…”

“…The increased use of HSCT and prolonged survival after the procedure improved our knowledge of its long-term adverse effects in adulthood [ 9 , 10 ]. An increase in the incidence of systemic conditions, such as cardiovascular diseases and metabolic syndromes, as well as various types of endocrine disorders, is seen in patients after HSCT compared with the general population [ 1 , 8 , 11 , 12 ]. Baker et al showed that patients treated with HSCT had 3.65-fold higher risk of diabetes and approximately twofold higher risk of hypertension compared with controls [ 13 ].…”

“…Some of these disorders may develop several years after the procedure. Therefore, markers allowing for their prediction might lead to more effective prevention and improved quality of life of long-term HSCT survivors [ 1 ].…”

“…Metabolic disorders in children after HSCT are poorly characterized, and very limited data are available. Preliminary reports indicate that lipid abnormalities in patients after HSCT (occurring most often up to 6 months after transplantation) are key predictors of metabolic disorders in future [ 1 , 4 , 14 , 15 ]. Dyslipidemia and insulin resistance are particularly common in patients after HSCT, and more than 80% of them fulfill diagnostic criteria for dyslipidemia at least once within the first 100 days after transplantation [ 4 , 5 , 16 ], which, according to the established evidence, is associated with increased rates of late mortality [ 5 , 10 , 11 , 15 , 17 ].…”