Abstract
ObjectivesIn this study, it was aimed to determine the prevalence and clinical features of obesity and metabolic syndrome, which are long-term effects of survivors after treatment in children with leukemia and lymphoma.Patients and MethodsPatients with leukemia and lymphoma, who were diagnosed between 2000 and 2012 (at least 2 two years after remission) were included. Data obtained through reviewing the family history, demographic characteristics, anthropometric measurements, and laboratory parameters (blood glucose, lipid, and insulin levels) were analyzed and compared at the time of diagnosis, after the treatment and at time of the study.ResultsEighty nine patients (45 boys, 44 girls) were included (mean age: 14.7 ± 4.3 years): 77.5% had acute lymphoblastic leukemia, 11.2% had acute myeloid leukemia, and 11.2% had lymphoma. Overall, 46% patients had received radiotherapy, 7% had undergone surgery, and 2.2% had received stem cell transplantation in addition to chemotherapy. The mean duration of treatment was 2.4 years, and the time elapsed after treatment was 4.9 years. While only one had obesity at the diagnosis, a significant increase in obesity (20%), hypertension (15.7%), hyperglycemia (15%), insulin resistance (35%) were observed at the time of study, and family history of hypertension, dyslipidemia, and cardiovascular diseases were significantly higher in this subgroup.ConclusionThe prevalence of metabolic syndorme is higher in children with leukemia and lymphoma after treatment, and begins to increase with the initiation of treatment and continues to increase over time. These children should be followed-up for late-effects including metabolic syndrome through life-long period.
Highlights
A large proportion of patients who are long-term survivors of childhood cancer experience complications or “late effects” that reduce their survival chances or quality of life later in their lives as a result of long-term effects of cancer treatments [1]
The survivors of hematological malignancies are predisposed to the development of metabolic syndrome (MetS), which is a clinical picture formed by the combination of interrelated risk factors such as high blood pressure [≥ 130/85 mm of mercury], high waist circumference(> 102 cm in males and > 88 cm in females), blood lipid disorders (triglyceride levels > 150 mg/dl, high density lipoprotein cholesterol (HDL-C) < 40 mg/dl), and impaired glucose tolerance, which in turn increases the risk of cardiovascular disease (CVD) and type 2 diabetes [8, 9]
Regarding diagnostic characteristics of the patients, it was found that 77.5% had acute lymphoblastic leukemia (ALL), 11.2% had acute myeloid leukemia (AML), and 11.2% had lymphoma; the mean age at diagnosis was 7.4 ± 4.3 years, and body mass index (BMI) at diagnosis was 17 ± 2.4 kg/ m2
Summary
A large proportion of patients (approximately 60%) who are long-term survivors of childhood cancer experience complications or “late effects” that reduce their survival chances or quality of life later in their lives as a result of long-term effects of cancer treatments [1]. The reported prevalence of obesity among adult survivors of childhood ALL ranges from 11 to 56% and varies based on reporting method and cohort characteristics [7]. The survivors of hematological malignancies are predisposed to the development of metabolic syndrome (MetS), which is a clinical picture formed by the combination of interrelated risk factors such as high blood pressure [≥ 130/85 mm of mercury (mmHg)], high waist circumference(> 102 cm (cm) in males and > 88 cm in females), blood lipid disorders (triglyceride levels > 150 mg/dl, high density lipoprotein cholesterol (HDL-C) < 40 mg/dl), and impaired glucose tolerance (glucose ≥ 100 mg/dl), which in turn increases the risk of cardiovascular disease (CVD) and type 2 diabetes [8, 9]. Cardiovascular morbidity and mortality are noted to increase in cancer survivors [10]
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