Energy balance and fitness in adult survivors of childhood acute lymphoblastic leukemia

Abstract

• Elimination of cranial radiation from therapy for childhood acute lymphoblastic leukemia has improved bodycomposition outcomes.• Survivors of childhood acute lymphoblastic leukemia treated without cranial radiation remain at risk for impaired fitness.There is limited information on body composition, energy balance, and fitness among survivors of childhood acute lymphoblastic leukemia (ALL), especially those treated without cranial radiation therapy (CRT). This analysis compares these metrics among 365 ALL survivors with a mean age of 28.6 6 5.9 years (149 treated with and 216 without CRT) and 365 age-, sex-, and race-matched peers. We also report risk factors for outcomes among survivors treated without CRT. Male survivors not exposed to CRT had abnormal body composition when compared with peers (% body fat, 26.2 6 8.2 vs 22.7 6 7.1). Survivors without CRT had similar energy balance but had significantly impaired quadriceps strength (221.9 6 6.0 Newton-meters [Nm]/kg, 60°/s) and endurance (211.4 6 4.6 Nm/kg, 300°/s), exercise capacity (22.0 6 2.1 ml/kg per minute), low-back and hamstring flexibility (24.7 6 1.6 cm), and dorsiflexion range of motion (23.1 6 0.9°) and higher modified total neuropathy scores (11.6 6 1.1) than peers. Cumulative asparaginase dose ‡120 000 IU/m 2 was associated with impaired flexibility, vincristine dose ‡39 mg/m 2 with peripheral neuropathy, glucocorticoid (prednisone equivalent) dose ‡8000 mg/m 2 with hand weakness, and intrathecal methotrexate dose ‡225 mg with dorsiflexion weakness. Physical inactivity was associated with hand weakness and decreased exercise capacity. Smoking was associated with peripheral neuropathy. Elimination of CRT from ALL therapy has improved, but not eliminated, body-composition outcomes. Survivors remain at risk for impaired fitness. (Blood. 2015;125(22):3411-3419)

Obesity and Metabolic Syndrome Among Adult Survivors of Childhood Leukemia

“…Similarly, we reported higher mean body fat percentages (4.5% males, 2.0% females) and lower mean percent skeletal muscle mass (2.6% males, 2.2% females), but no difference in BMI, comparing 75 ALL survivors (mean age 30.2 years) to age and sex matched controls [17]. These results were replicated in a larger study (365 ALL survivors, 365 age and sex matched controls) among survivors treated with cranial radiation therapy (CRT) (4.5% higher body fat among males; 3.5% higher body fat among females), as well as among males treated with CRT (6.4% higher body fat) [18]. …”

A Review of Cardiorespiratory Fitness in Adolescent and Young Adult Survivors of Childhood Cancer: Factors that Affect its Decline and Opportunities for Intervention

“…18 In a separate study in the childhood ALL survivor population, with a median of 21.9 years of follow-up, Ness et al compared CRF in survivors treated with or without cranial radiation with age-and sex-matched peers, finding significant impairments in both groups of survivors, compared with age-, sex-, and race-matched peers. 19 Tonorezos et al assessed CRF in adult survivors of childhood ALL, with the majority of cases more than 15 years post-diagnosis. Compared with age-, sex-, and race-matched controls, survivors had lower CRF (VO 2max survivors: 30.7 mL/kg/min) than controls (VO 2max controls: 39.9 mL/kg/min, p < 0.0001).…”

Balance deficits in long-term pediatric ALL survivors

“…The performance of two tasks is unaffected if the person has enough attentional resources (i.e., the information-processing resources that are required to complete a task [1]); otherwise, performance on the cognitive task, balance task, or both can be impaired. Many long-term ALL survivors experience deficits in muscle strength and flexibility [6]. To compensate for this physical disadvantage, they may devote more attentional resources to perform a dynamic task, such as walking on a busy street.…”