Cardiometabolic Risk Factors in Childhood, Adolescent and Young Adult Survivors of Acute Lymphoblastic Leukemia \u2013 A Petale Cohort

Emile Levy,Caroline Laverdière,Laurence Bertout,Daniel Sinnett,Valérie Marcil,Maja Krajinovic,Mariia Samoilenko,Geneviève Lefebvre,Sophia Morel,Jade England,Simon Drouin,Devendra Amre

doi:10.1038/s41598-017-17716-0

Abstract

Our objectives were to assess the prevalence of cardiometabolic complications in children, adolescents, and young adult survivors of childhood acute lymphoblastic leukemia (cALL), to identify their predictors and the risk compared to the Canadian population. We performed a cardiometabolic assessment of cALL survivors from the PETALE cohort (n = 247, median age at visit of 21.7 years). In our group, overweight and obesity affected over 70% of women. Pre-hypertension and hypertension were mostly common in men, both adults (20%) and children (19%). Prediabetes was mainly present in women (6.1% of female adult survivors) and 41.3% had dyslipidemia. Cranial radiation therapy was a predictor of dyslipidemia (RR: 1.60, 95% CI: 1.07–2.41) and high LDL-cholesterol (RR: 4.78, 95% CI: 1.72–13.28). Male gender was a predictor for pre-hypertension and hypertension (RR: 5.12, 95% CI: 1.81–14.46). Obesity at the end of treatment was a predictor of obesity at interview (RR: 2.07, 95% CI: 1.37–3.14) and of metabolic syndrome (RR: 3.04, 95% CI: 1.14–8.09). Compared to the general population, cALL survivors were at higher risk of having the metabolic syndrome, dyslipidemia, pre-hypertension/hypertension and high LDL-cholesterol, while the risk for obesity was not different. Our results support the need for early screening and lifestyle intervention in this population.

Highlights

The high prevalence of obesity and cardiometabolic complications in childhood acute lymphoblastic leukemia (cALL) survivors is not fully understood
One of the main objectives of the PETALE initiative was to characterize early-onset late adverse effects in a homogenous population of CAYA cALL survivors exposed to Dana Farber Cancer Institute protocols from 1987 to 2005
Evaluation of this cohort exposed the high prevalence of cardiometabolic complications and supported an increased cardiovascular risk compared to the general Canadian population, extending the observations obtained by other groups in older cohorts[4,5,6,7,8,9,20]

Summary

Introduction

The high prevalence of obesity and cardiometabolic complications in cALL survivors is not fully understood. Since treatment protocols are trending towards less use and lower doses of CRT, one could ask whether patients treated with modern therapy are still at risk of long-term cardiometabolic complications[15]. While CRT in doses of 20 Gray (Gy) or more was identified as the primary risk factor for obesity[16], doses between 10 and 20 Gy used in more recent protocols were associated with an increased risk[16] indicating that survivors are still at risk despite lower CRT exposition. Other possible risk factors for obesity in cALL survivors include age and body mass index (BMI) at diagnosis[17,18,19]. The age of onset of cardiometabolic complications in cALL survivors remains nebulous since most studies have dealt with adult patients, with little data on childhood, adolescent and young adult (CAYA) survivors. Few comprehensive comparisons to cohorts of national data have been carried out, especially in CAYA

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Conclusion