Early Indicators of the Dysmetabolic Syndrome in Young Survivors of Acute Lymphoblastic Leukemia in Childhood.

An increased incidence of obesity and cardiovascular morbidity and mortality was recently observed in adult survivors of childhood malignancies younger than 45 years. The purpose of this study was to investigate the presence of early indicators of the dysmetabolic syndrome in a population of young survivors of acute lymphoblastic leukemia (ALL) in childhood.

Patients and methods: Our study included 58 patients (31 males), aged 5–24 years (mean 12.9 years) with ALL, who had finished their treatment by the same protocol at least 2 years before the study (mean 5.1 years, range 2–10 years). Ten patients had received cranial irradiation (18 Gy). No patient had a history of thyroid disease or diabetes mellitus or received hormonal substitution. We obtained a detailed history of their diet habits and level of physical activity and measured their body mass index (BMI) and blood pressure (BP). Complete blood counts and blood chemistry tests were also obtained. Finally, bone density was measured in the lumbar spine and femur with DEXA.

Results: Diet enriched in lipids and low carbohydrates was reported by 43/58 (74%), while absence of any athletic activity by 38/58 (65%) of the patients. Frank obesity with a BMI >30 or its equivalent for age and gender was observed in 12/58 (21%) of the patients, while 25/58 (43%) were overweight, with a BMI >25<30 or its equivalent for age and gender.¹ Increased systolic and/or diastolic BP (>95^th percentile) was observed in 13/58 patients (22%), while in 25/58 (43%) it was > the 75^th percentile. Dyslipidemia characterized by one, two, or three indices (serum cholesterol, triglycerides or LDL concentrations >95^th percentile) was respectively detected in 20/58 (35%), 13/58 (22%), and 7/58 (12%) of the patients. Reduced serum HDL concentrations (<5^th percentile) was observed in 12/58 (21%) of the patients. Slightly elevated free fatty acids were detected in 11/58 (19%) and hepatic enzymes in 7/58 (12%) of the patients. Increased fasting insulin was seen in 14/58 (24%) of the patients and HbA_1c in 11/58 (19%) of them, however, fasting blood glucose was normal in all patients. Finally, increased inflammatory indices, namely C-reactive protein (CRP) or serum amyloid A (SAA), were detected in 9/58 patients (15%), reduced IGF-1 in 9/58 (15%) and thyroid hormone abnormalities in 5/58 (9%). All the patients with thyroid dysfunction, however, had received cranial irradiation. Osteopenia [Ζ score matched for age and gender of T score bone density: -(1–2.5) SD] was detected in 41/58 (71%) of the patients. None had frank osteoporosis.

Conclusion: Survivors of childhood ALL have early indicators of high risk for the dysmetabolic syndrome. Modification of diet, body weight control, stress reduction, and reinforcement of an exercise program will hopefully be helpful in preventing the cardiovascular sequelae of the syndrome, improve the quality of life and enhance the life expectancy in this group of patients.