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

Saultier, Paul; Auquier, Pascal; Bertrand, Yves; Vercasson, Camille; Oudin, Claire; Contet, Audrey; Plantaz, Dominique; Poirée, Marilyne; Ducassou, Stéphane; Kanold, Justyna; Tabone, Marie‐Dominique; Dalle, Jean‐Hugues; Lutz, Patrick; Gandemer, Virginie; Sirvent, Nicolas; Thouvenin, Sandrine; Berbis, Julie; Chambost, Hérvè; Baruchel, André; Leverger, Guy; Gautier, Michel

doi:10.3324/haematol.2016.148908

Cited by 43 publications

(28 citation statements)

References 52 publications

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“…2,4,7,25,26 Children after therapy of ALL are also at substantial risk of cardiovascular disease development in adulthood. 15,16,27 It was also confirmed that cancer childhood survivors are approx. 8 times more likely to die due to cardiac-related events as compared to the general population.…”

Section: Discussionmentioning

confidence: 74%

CIMT does not identify early vascular changes in childhood acute lymphoblastic leukemia survivors

Ociepa¹,

Posio²,

Sawicki³

et al. 2020

Adv Clin Exp Med

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Background. Childhood acute lymphoblastic leukemia (ALL) survivors are at an increased risk of cardiovascular disease development. It is believed that in the general population, this risk can be predicted with carotid intima-media thickness (CIMT) measurement. Objectives. The objective of this study was to assess CIMT and to investigate the effects of blood pressure (BP) and lipid profile values on CIMT in childhood ALL survivors. Material and methods. The study group comprised 81 childhood ALL survivors aged 5-25 years. The control group consisted of 52 age-and sex-comparable healthy children. Carotid intima-media thickness measurement, 24-hour BP monitoring and lipid profiles were evaluated in patients and controls. Results. Despite significantly higher proportion of subjects with arterial hypertension (AH) (30/81 vs 10/52; p = 0.0315), the mean values of CIMT were not statistically different in childhood ALL survivors as compared to controls (0.4303 ±0.03 vs 0.4291 ±0.03; p = 0.81 and 1.096 ±0.74 vs 1.027 ±0.55; p = 0.56, respectively). Carotid intima-media thickness values were not statistically higher in ALL survivors with AH as compared to ALL survivors with normal BP (0.433 ±0.03 vs 0.428 ±0.03; p = 0.82). A significant positive correlation between 24-hour systolic BP standard deviation score (SDS) and CIMT-SDS in childhood ALL survivors was found (r = 0.29, p = 0.009), whereas such correlation was not observed in healthy controls (r = 0. 12, p = 0.39). A significant correlation between z-score body mass index (BMI) and CIMT was found in controls (r = 0.29, p = 0.031) but not in childhood ALL survivors (r = −0.05, p = 0.64). No significant correlations between CIMT and other measured variables were found. Carotid intima-media thickness did not significantly correlate with time since ALL diagnosis (r = 0.09, p = 0.39). Conclusions. Carotid intima-media thickness measurement shows limited feasibility and diagnostic accuracy for early assessment of vascular alteration in childhood ALL survivors. Other tests are needed to predict cardiovascular risk in childhood ALL survivors at the early stage of the follow-up.

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Section: Discussionmentioning

confidence: 74%

CIMT does not identify early vascular changes in childhood acute lymphoblastic leukemia survivors

Ociepa¹,

Posio²,

Sawicki³

et al. 2020

Adv Clin Exp Med

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“…The risk of developing metabolic syndrome was even higher among patients who received CNS irradiation (OR: 2.32, 95%CI: 1.36–3.97; P =0.002), which confirms the results of previous studies. 15 , 17 , 38 Interestingly, those patients had a much larger waist circumference compared with the IPC group. This highlights the impact of CNS irradiation on the development of obesity, an observation which has been previously described 11 , 41 , 42 and debated.…”

Section: Discussionmentioning

confidence: 90%

“… 50 Therefore, TBI exposure may induce adipose tissue abnormalities, as suggested by animal models, 51 and contribute to the development of metabolic syndrome. Our previous studies indicated that high-dose corticosteroids do not have an impact on metabolic syndrome, 11 , 15 and, therefore, this hypothesis remains controversial. 11 , 15 …”

Section: Discussionmentioning

confidence: 97%

Prevalence and characteristics of metabolic syndrome in adults from the French childhood leukemia survivors’ cohort: a comparison with controls from the French population

et al. 2018

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The prevalence of the metabolic syndrome among adults from the French LEA childhood acute leukemia survivors’ cohort was prospectively evaluated considering the type of anti-leukemic treatment received, and compared with that of controls. The metabolic profile of these patients was compared with that of controls. A total of 3203 patients from a French volunteer cohort were age- and sex-matched 3:1 to 1025 leukemia survivors (in both cohorts, mean age: 24.4 years; females: 51%). Metabolic syndrome was defined according to the National Cholesterol Education Program’s Adult Treatment Panel III criteria. Metabolic syndrome was found in 10.3% of patients (mean follow-up duration: 16.3±0.2 years) and 4.5% of controls, (OR=2.49; P<0.001). Patients transplanted with total body irradiation presented the highest risk (OR=6.26; P<0.001); the other treatment groups also showed a higher risk than controls, including patients treated with chemotherapy only. Odd Ratios were 1.68 (P=0.005) after chemotherapy only, 2.32 (P=0.002) after chemotherapy and cranial irradiation, and 2.18 (P=0.057) in patients transplanted without irradiation. Total body irradiation recipients with metabolic syndrome displayed a unique profile compared with controls: smaller waist circumference (91 vs. 99.6 cm; P=0.01), and increased triglyceride levels (3.99 vs. 1.5 mmol/L; P<0.001), fasting glucose levels (6.2 vs. 5.6 mmol/L; P=0.049), and systolic blood pressure (137.9 vs. 132.8 mmHg; P=0.005). By contrast, cranial irradiation recipients with metabolic syndrome had a larger waist circumference (109 vs. 99.6 cm; P=0.007) than controls. Regardless of the anti-leukemic treatment, metabolic syndrome risk was higher among childhood leukemia survivors. Its presentation differed depending on the treatment type, thus suggesting a divergent pathophysiology. This study is registered at clinicaltrials.gov identifier: 01756599.

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“…Poor diet and a sedentary lifestyle could further increase these already elevated risks. Personal counseling should be offered to childhood cancer patients and their parents throughout treatment and beyond, and special attention should be given to patients with an increased BMI (48). However, counseling during this period, when patients and families face the crisis of a life-threatening illness and nutritional status is not a first priority, is challenging.…”

Section: Implications and Recommendationsmentioning

confidence: 99%

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

Belle

Weiß

Schindler

et al. 2018

The American Journal of Clinical Nutrition

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Background: An increased risk of becoming overweight has been reported for childhood cancer survivors (CCSs), in particular leukemia survivors, although the evidence is inconclusive. Objective: We assessed the prevalence of overweight in CCSs, with a focus on leukemia survivors, compared it with their peers, and determined potential risk factors. Design: As part of the Swiss Childhood Cancer Survivor Study, we sent a questionnaire between 2007 and 2013 to all Swiss resident CCSs aged <21 y at diagnosis who had survived ≥5 y. We calculated body mass index (BMI) from medical records at diagnosis and self-reported heights and weights at survey. We calculated BMI z scores by using Swiss references for children and compared overweight prevalence in CCSs, their siblings, and the general population with the use of the Swiss Health Survey (SHS) and assessed risk factors for being overweight by using multivariable logistic regression. Results: The study included 2365 CCSs, 819 siblings, and 9591 SHS participants. At survey, at an average of 15 y after diagnosis, the prevalence of overweight in CCSs overall (26%) and in leukemia survivors (26%) was similar to that in siblings (22%) and the general population (25%). Risk factors for being overweight in CCSs were male sex (OR: 1.8; 95% CI: 1.5, 2.1), both young (OR for ages 5-14 y: 1.6; 95% CI: 1.2, 2.3) and older (range-OR for ages 25-29 y: 1.7; 95% CI: 1.2, 2.4; OR for ages 40-45 y: 4.0; 95% CI: 2.5, 6.5) age at study, lower education (OR: 1.4; 95% CI: 1.1, 1.8), migration background (OR: 1.3; 95% CI: 1.1, 1.7), and no sports participation (OR: 1.4; 95% CI: 1.1, 1.7). Risk factors for overweight were similar in peers. CCSs treated with cranial radiotherapy (≥20 Gy) were more likely to be overweight than their peers (OR: 1.6; 95% CI: 1.2, 2.2). Conclusions:The prevalence of and risk factors for being overweight are similar in long-term CCSs and their peers. This suggests that prevention methods can be the same as in the general population. An important exception is CCSs treated with cranial radiotherapy ≥20 Gy who may need extra attention during follow-up care. This study was registered at clinicaltrials.gov as NCT03297034. Am J Clin Nutr 2018;107:3-11.

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

Cited by 43 publications

References 52 publications

CIMT does not identify early vascular changes in childhood acute lymphoblastic leukemia survivors

CIMT does not identify early vascular changes in childhood acute lymphoblastic leukemia survivors

Prevalence and characteristics of metabolic syndrome in adults from the French childhood leukemia survivors’ cohort: a comparison with controls from the French population

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

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