Cardiometabolic Risks Among Survivors of Childhood Hematologic Malignancies.

Abstract 4113

Survival rates for childhood hematologic malignancies continue to improve. Research suggests these individuals are at increased risk for late adverse cardiovascular outcomes. This analysis includes children (n=101) who survived ≥ 5-yrs following diagnosis of acute lymphoblastic leukemia (ALL) (n=78), acute myeloid leukemia (AML) (n=5), and non-Hodgkin lymphoma (NHL) (n=18), compared to their frequency matched healthy siblings (n=123). Anthropometric measurements, blood pressure (BP), fasting glucose, insulin, and lipids were collected; insulin resistance was assessed by euglycemic hyperinsulinemic clamp, adjusted for lean body mass (low Mlbm represents insulin resistance); carotid artery stiffness (distensibility and compliance – low levels represent increased stiffness), adjusted for lumen diameter, was assessed by ultrasound. Least squares means and standard errors, adjusted for age, gender, pubertal development, and body mass index (BMI) were compared. Survivors (63.4% male) mean age at diagnosis was 10.3 yrs (5.7-15.8) and 15.0 yrs (9.9-17.9) at evaluation; siblings (56.1% male) were 13.6 yrs (9.0-18.0) at evaluation. Among survivors, 88 (87.1%) received chemotherapy only and 13 (12.9%) chemotherapy and cranial radiation. Metabolic syndrome (MS) (modified criteria for children) was present in 8 (7.9%) survivors vs. 6 (4.9%) siblings (p=0.35). Nevertheless, 25 (24.8 %) survivors had two or more MS components compared to 17 (13.8 %) siblings (p=0.04). There were no differences between cases and siblings on measures of adiposity (BMI, waist circumference, % body fat, visceral fat), BP, fasting glucose, insulin, and lipids. However, survivors were significantly more insulin resistant and had stiffer carotid arteries compared to controls (Table). Despite similar levels of adiposity, survivors of childhood hematologic malignancies demonstrate signs of insulin resistance and increased vascular stiffness at a young age compared to healthy controls. These findings highlight: 1) the heightened cardiovascular risk profile among children who survived hematologic malignancies and 2) that the typical components of the MS may not be sufficiently sensitive measures of risk in this young population.