Evaluation of Endocrine Late Complications in Childhood Acute Lymphoblastic Leukemia Survivors: A Report of a Single-Center Experience and Review of the Literature

Abstract

Objective:Improvement in long-term survival in patients with acute lymphoblastic leukemia (ALL) in childhood has led to the need for monitorization of treatment-related morbidity and mortality. In the current study, we aimed to evaluate endocrine side effects of treatment in ALL survivors who were in remission for at least 2 years.Materials and Methods:Sixty patients diagnosed with ALL, who were in remission for at least 2 years, were cross-sectionally evaluated for long-term endocrine complications.Results:The median age of the patients at the time of diagnosis, at the time of chemotherapy completion, and at the time of the study was 5 years (minimum-maximum: 1.7-13), 8 years (minimum-maximum: 4.25-16), and 11.7 years (minimum-maximum: 7-22), respectively, and median follow-up time was 4 years (minimum-maximum: 2-10.1). At least one complication was observed in 81.6% of patients. Vitamin D insufficiency/deficiency (46.6%), overweight/obesity (33.3%), and dyslipidemia (23.3%) were the three most frequent endocrine complications. Other complications seen in our patients were hyperparathyroidism secondary to vitamin D deficiency (15%), insulin resistance (11.7%), hypertension (8.3%), short stature (6.7%), thyroid function abnormality (5%), precocious puberty (3.3%), and decreased bone mineral density (1.7%). There were no statistically significant correlations between endocrine complications and age, sex, and radiotherapy, except vitamin D insufficiency/deficiency, which was significantly more frequent in pubertal ALL survivors compared to prepubertal ALL survivors (57.5% and 25%, respectively, p=0.011).Conclusion:A high frequency of endocrine complications was observed in the current study. The high frequency of late effects necessitates long-term surveillance of this population to better understand the incidence of late-occurring events and the defining of high-risk features that can facilitate developing intervention strategies for early detection and prevention.

Changes in nutritional status in adolescents surviving leukemia and lymphoma

“…Based on the BMI/A measures, Nakhaei-Moghadam et al [16] found a prevalence of 29.2% overweight and 16.7% obesity, and no association between patients' weight gain and type of treatment, gender and age. According to other studies the prevalence of obesity after antineoplastic treatment of ALL in childhood varies from 16% to 56% approximately, and may be related to cranial radiation, treatment with corticosteroids, physical inactivity and increased calories intake [8,21]. Our study found a higher patients' eutrophy prevalence in M3, corroborating the data from other investigations, where the patients who survived leukemias were eutrophic utilizing the same parameters as BMI/A [17].…”

“…Our study found a higher patients' eutrophy prevalence in M3, corroborating the data from other investigations, where the patients who survived leukemias were eutrophic utilizing the same parameters as BMI/A [17]. Different results were obtained in a case-control study where the survivors of ALL in childhood were at greater risk for overweight or obesity during follow up compared to the Control Group; a significant difference in the mean weight and BMI was found, both of them being greater in the ALL survivors [21].…”

“…Survivors of cancer in childhood presented late effects that may appear earlier or over the long term, such as growth deficit and excess weight in female individuals. Studies have shown a major prevalence of excess weight in patients who are cancer survivors, especially in those with a high BMI at diagnosis [20,21]. In the present study there was an increase in the Z-score BMI/A indicator between M1 and M2, as well as between M1 and M3.…”

“…Patients undergoing radiotherapy treatment associated with corticotherapy had a higher growth deficit at the end of the treatment when compared to patients receiving only glucocorticoids [28]. Corticosteroid therapy is often associated with overweight and obesity in survivors of childhood cancer [21].…”

Mechanism of Propolis Affecting Oral Flora Structure and Immune Microenvironment of Oral Mucositis in Patients with Leukemia Undergoing Chemotherapy

“…In recent years due to the increase in the intensity, type and dose of chemotherapy, monoclonal antibodies, large doses of immunosuppressants and targeted therapy and application of broad-spectrum antibiotics, some fungal infections have increased in newly diagnosed or relapsed leukemia patients and the incidence of oral mucosa destruction in patients has reached 40 % to 80 % [11] . Therefore, it is of great significance to find suitable methods for the protection and treatment of oral internal environment of leukemia patients after chemotherapy.…”