Increased Cardiometabolic Traits in Pediatric Survivors of Acute Lymphoblastic Leukemia Treated with Total Body Irradiation

Survivors of childhood acute lymphoblastic leukemia (ALL) may face an increased risk of metabolic and cardiovascular late effects To determine the prevalence of and risk factors for adverse cardiometabolic traits in a contemporary cohort of pediatric ALL survivors we recruited 48 off-therapy patients in remission treated with conventional chemotherapy and 26 treated with total body irradiation (TBI)-based hematopoietic cell transplantation (HCT) in this cross-sectional pilot study At a median age of 15 years (range 8 21 years) HCT survivors were significantly more likely than non-HCT survivors to manifest multiple cardiometabolic traits including central adiposity hypertension insulin resistance and dyslipidemia Overall 23 1% of HCT survivors met the criteria for metabolic syndrome (>= 3 traits) compared with 4 2% of non-HCT survivors (P = 02) HCT survivors also had increased C-reactive protein and leptin levels and decreased adiponectin suggestive of underlying inflammation and increased visceral fat In multivariate analyses history of HCT remained associated with >= 2 traits (odds ratio [OR] 5 13 95% confidence interval [CI] 1 54-17 15) as well as with >= 3 traits (OR 16 72 95% CI 1 66-168 80) Other risk factors included any cranial radiation exposure and family history of cardiometabolic disease In summary pediatric ALL survivors exposed to TBI-based HCT as well as to any cranial radiation may manifest cardiometabolic traits at an early age and should be screened accordingly Biol Blood Marrow Transplant 16 1674-1681 (2010) (C) 2010 American Society for Blood and Marrow Transplantation