Serial plasma concentrations of PYY and ghrelin during chemotherapy in children with acute lymphoblastic leukemia

Purpose: To investigate peptide YY (PYY) and ghrelin secretion, at diagnosis and during chemotherapy in children with acute lymphoblastic leukemia (ALL). Patients and Methods: Measurements were performed at diagnosis, after the induction-consolidation phase and at standard time points before each cycle in 9 patients with ALL aged 2 to 7 years (median 4.3 y). Body mass index (BMI) and leukemic burden were estimated at the same time points and correlated with PYY and ghrelin levels. Nine healthy children matched for age and sex were used as controls. Results: At diagnosis, mean PYY levels were high (P < 0.0001) and mean active ghrelin were low, compared with controls (P<0.001). Compared with baseline values, PYY increased significantly after the induction-consolidation phase (P = 0.033), and returned progressively to pretreatment levels after the sixth cycle, whereas ghrelin fluctuated and stabilized at significantly higher levels (P = 0.024) after the eighth cycle of chemotherapy. However, ghrelin was still low, compared with controls (P < 0.001), after the eighth cycle. Delta (final-baseline) mean PYY was negatively correlated with 6 mean BMI SD score (-0.612, P = 0.010) and positively with leukemic burden (0.529, P = 0.015), whereas delta mean ghrelin was positively correlated with delta mean BMI SD score (0.626, P = 0.009) and negatively with leukemic burden (-0.567, P = 0.012). Conclusions: PYY and ghrelin play a major role in pathogenesis of anorexia-cachexia syndrome in pediatric ALL patients.