Abstract
Introduction: Metabolic and endocrine complications are common complications in the treatment of Acute Lymphoblastic Leukemia (ALL). Inappropriate anti-diuretic hormone (ADH) syndrome, diabetes mellitus, hypoglycemia, surrenal failure, hypercalcemia may ocur during the treatment. Obesity, growth retardation or pause and osteopenia are the most common complications. These complications are usually due to combined chemotherapeutic agents used during the treatment. In this study, we present the metabolic/endocrine complications which are observed during treatment of ALL patients at our center.
Material -Metod: One hundred and ten patients who were diagnosed with ALL and treated with the 'Children's Oncology Group' (COG) protocol and follow-up in the Pediatric Hematology / Oncology Department of the Istanbul University Institute of Oncology were included in the study. We retrospectively analyzed the demographic characteristics of the patients and presence of metabolic/endocrin problems (hyperglycemia, hypoglycemia, hypothyroidism, hypercholesterolemia, obesity) during all treatment stages were recorded. Forty-five (40.9%) of the patients were female and 65 (59.1%) were male. Ninety-seven (88.2%) patients were pre-B-cell ALL, 1 (0.9%) patients were mature B-cell ALL, 11 (10%) patients were T-cell ALL and 1 (0.9%) patients were biphenotypic ALL. The median age of the patients were 7 years (range:1,5-23).
Results: One hundred of the 110 patients whose all clinical data were obtained were included for the evaluation of the metabolic and endocrin complications. The metabolic and endocrine problems were detected in 16 (16%) patients in any phases of the treatment and 84 (84%) patients did not have any metobolic or endocrine problems during the treatment. Twelve (12%) of the 16 patients with metabolic and endocrine problems were in 1 phase and 4 (4%) in 2 phases. Totally, 23 problems were detected. All metabolic / endocrine problems that arise during treatment are shown in Table 1. Seven of them (30.4%) were in induction, 2 of them were in consolidation (8.8%), no problems were found in interim maintenance 1, 7 (30.4%) were in delayed intencification, Interim maintenance 2 and delayed intencification 2 did not show any problems, and 7 (30.4%) were seen in maintenance.
Conclusion: In the treatment of ALL, endocrine and metabolic problems are frequently seen during and after treatment. In our study, 23 metabolic problems (hyperglycemia, hypoglycemia, hypothyroidism, hypertriglyceridemia, hypercholesterolemia, osteoporosis, obesity, hyperferritinemia, metabolic syndrome) were recorded in 16 (16%) of the patients. Our resuts suggest that metabolic complications that may occur in ALL treatment should be considered as well as the remission of the disease. Therefore, patients should be carefully evaluated for metabolic and endocrin problems in ALL treatment.
No relevant conflicts of interest to declare.
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