Metabolic Syndrome in Children and Adolescents With Acute Lymphoblastic Leukemia After the Completion of Chemotherapy

Abstract

The metabolic syndrome is a cluster of potent risk factors for cardiovascular diseases. To provide information on the late complications of chemotherapy for acute lymphoblastic leukemia (ALL), the authors prospectively studied the frequency of overweight, obesity, and metabolic syndrome in survivors of ALL in the initial years after the completion of therapy. Children and adolescents were classified as having the metabolic syndrome if they met three or more of the following criteria: hypertriglyceridemia, low levels of high-density lipoprotein (HDL), high fasting glucose, obesity, and hypertension. Obesity was defined on the basis of Body Mass Index (BMI) (kg/m2) standard deviation scores or z-scores. Cutoff points for triglycerides and HDL were taken from equivalent pediatric percentiles with the cutoff points proposed by the Adult Treatment Panel III (ATPIII). Hyperglycemia was defined using the ATPIII cutoff points. Elevated systolic or diastolic blood pressure was defined as a value greater than the 95th percentile for age, gender, and height. Fifty-two subjects (29 male and 23 female) with a median age of 15.2 years (range 6.1-22.6 years) were evaluated. Median interval since completion of therapy was 37 months (range 13-121 months). All of them had been treated according to the ALL-BFM 90 chemotherapy protocol and none had received cranial radiotherapy. Of the 52 subjects, 25 (48%) were overweight (BMI z-score >1.5) and 3 (5.76%) were obese (BMI z-score >2); among them, 1 was severely obese (BMI z-score >2.5). Three criteria for the metabolic syndrome (high triglyceride levels, glucose intolerance, and obesity) were fulfilled by three subjects (5.76%). Twenty-nine subjects (55.7%) had at least one risk factor for metabolic syndrome. Hyperglycemia and hypertension were infrequent. Prompt recognition of the risk factors for metabolic syndrome and intervention seem mandatory to ensure early prevention of cardiovascular disease in survivors of ALL.

Prevalence of the Metabolic Syndrome and Associated Factors in Korean Cancer Survivors

“…Previous studies from western countries have demonstrated that the results varied according to cancer types. Cancer survivors from hematologic malignancies showed higher odds ratios for metabolic syndrome (Kourti et al, 2005;Follin et al, 2006;Gurney et al, 2006;Trimis et al, 2007). However, inconsistent results were observed in cancer survivors with solid tumors (Nuver et al, 2005;Braga-Basaria et al, 2006;Haugnes et al, 2007).…”

Obesity in Pediatric ALL Survivors: A Meta-Analysis

“…These survivors had completed treatment within 10 years at the time of study evaluation. 8,12,13,16,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Only 2 studies 14,40 examined BMI z score assessed $10 years after the completion of treatment (ie, off treatment $10 years). Because neither study reported SD/SE of the BMI z score, the meta-analysis did not include survivors who were off treatment beyond 10 years.…”

“…6 Although different definitions were used to assess obesity, there was a consistently high prevalence of overweight/obesity in both recent and long-term survivors. The prevalence of overweight/obese survivors exceeded 40% in 11 studies that included pediatric ALL survivors off treatment ,5 years (mean/median age = 7.3-15.2 years) 27,28,32,34,[49][50][51] (Table 1). The prevalence of overweight/obesity ranged between 29% to 69% in 14 studies that Age at study and year since Dx are the mean or median as reported or estimated based on the reported age at diagnosis and duration of follow-up (the mean duration of treatment was estimated to be 2.5 y if not indicated by the study).…”

Metabolic syndrome in long-term survivors of childhood acute leukemia treated without hematopoietic stem cell transplantation: an L.E.A. study

“…In this population, the prevalence of MetS is particularly high. [9][10][11] Previous studies have investigated MetS prevalence among childhood AL patients treated without HSCT, [12][13][14][15][16][17][18] although most of these studies had distinct limitations: (I) child or very young adult populations, (II) self-administered questionnaires, (III) single-center studies, (IV) small cohort size, or (V) retrospective design. Thus, the reported MetS prevalence among patients treated without HSCT is quite variable, with values ranging from 8.3% to 31.7%.…”