Cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia (ALL).

Abstract

9509 Background: Childhood ALL survivors have an elevated risk of premature cardiovascular disease. Methods: Maximal oxygen uptake (VO2max) was measured in 118 adult survivors of childhood ALL (median age, 23.0 years; range, 18 to 37). To adjust for body fat, VO2max (ml/kg/min) was also expressed relative to lean mass (ml/kg lean mass/min). We compared VO2max measurements for ALL survivors to those estimated from a frequency matched (age, gender, race/ethnicity) sample from the 2003-2004 National Health and Nutritional Examination Survey (NHANES). Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest. Results: Compared to NHANES participants, ALL survivors had a substantially lower VO2max (mean 29.2 vs 38.9 ml/kg/min; P<0.001) and VO2max relative to lean mass (mean 43.4 vs 60.6 ml/kg lean mass/min; P<0.001). Further, each subgroup of ALL survivors, based upon key treatment exposures (cranial radiotherapy [CRT], anthracycline chemotherapy), had substantially lower VO2max compared with NHANES participants. In multivariate models including only ALL survivors, treatment exposure was associated with VO2max. Among females, CRT was associated with low VO2max (P = 0.02), but anthracycline exposure > 100 mg/m2was not (P = 0.58). In contrast, among males, anthracycline exposure > 100 mg/m2 was associated with low VO2max (P = 0.03), but CRT was not (P = 0.54). Conclusions: Adult survivors of childhood ALL, regardless of treatment exposure, have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population. Cardiorespiratory fitness (mean VO2max) for ALL survivors and NHANES participants. Group VO2max ml/kg/minute P* NHANES (N=570) 39.9 ALL survivors, total (N=118) 29.2 <0.001 CRT, no (N=78) 31.6 <0.001 CRT, yes (N=40) 24.7 <0.001 Anthracycline, none (N=33) 29.1 <0.001 Anthracycline, 60-80 mg/m2(N=45) 30.8 <0.001 Anthracycline, > 100 mg/m2 (N=40) 27.6 <0.001 * P value comparing cardiorespiratory fitness between ALL survivors (or treatment subgroup) and NHANES participants, adjusted for age at testing, gender, race/ethnicity, and current smoking status.