High incidence of obesity in young adults after treatment of acute lymphoblastic leukemia in childhood

Summary:Excess fatness is frequent after childhood ALL treated without BMT. We measured the whole-body percent fat by dual-energy X-ray absorptiometry and the bodymass index (weight/height 2 (kg/m 2 ), BMI) in 25 survivors of childhood leukaemia or lymphoma (21 with ALL) who had received TBI and allogeneic BMT a median of 8 years ago (range 4-13). Adjusted for sex and age, the mean BMI was slightly but significantly reduced (0.4 s.d. below predicted) and the whole-body percent fat was significantly increased compared with healthy controls (1.1 s.d. above predicted). Eleven of 25 patients had a percent fat above the 90 percentile of the reference values, which indicates excess fatness. Adjusted for sex and age, a higher percent fat was related to additional cranial irradiation. Controlled for this, the whole-body percent fat seemed to be unrelated to age at BMT, length of follow-up, and previous chemotherapy. Compared with untransplanted ALL survivors treated with cranial irradiation, BMT survivors had significantly reduced BMI but similar whole body percent fat. BMI was a poor measure of body fatness in these patients. In conclusion, survivors of BMT for childhood leukaemia or lymphoma are adipose and slightly underweight and consequently have a substantially reduced lean body mass. Bone Marrow Transplantation (2001) 27, 817-820. Keywords: leukaemia; lymphoma; childhood; late sideeffects of therapy; body-mass index; body composition During the last decades the survival rates after childhood leukaemia and lymphoma have risen considerably. 1 For children with very high risk 2 or relapsed disease, 3-5 allogeneic BMT with a related donor will give the highest chance of survival. Unfortunately, allogeneic BMT for childhood cancer has frequent and severe delayed side-effects.Body-mass index (weight/height 2 (kg/m 2 ), BMI) is considered the best available weight-stature index in both chil- dren and adults, regarding independence of stature, correlation with body fat, and prediction of mortality. 6 Raised BMI (overweight) in childhood and adolescence increases the risk of being overweight in adulthood, 7,8 and overweight in adolescence 9 and adulthood 10,11 is associated with excess morbidity and mortality. In industrialised countries, the frequency of overweight people has increased over the last decades. 12 Whole-body dual-energy X-ray absorptiometry (DXA) is currently considered the most valid practically usable method for non-invasively measuring the body composition according to a three-compartment model based on bone mineral mass, fat mass, and non-fat non-mineral mass. 13,14 Impaired growth hormone secretion is frequent after cranial or total body irradiation for childhood cancer. 15,16 Growth hormone deficient children 17 and adults 18 are adipose, also when matched for BMI. Consequently, BMI is a less valid measure of adiposity in survivors of childhood cancer than in the background population. The BMI [19][20][21][22][23][24][25] and the degree of fatness 25-27 after childhood ALL treated without BMT have bee...

Section: Discussionmentioning

confidence: 75%

mentioning

confidence: 99%

Degree of fatness after allogeneic BMT for childhood leukaemia or lymphoma

Nysom

Holm

Michaelsen

et al. 2001

“…These factors could explain the lower incidence of obesity after TBI as opposed to cranial irradiation only. 31 They could also explain the difference we observed between BU or TBI patients. If confirmed, these results could be determining for clinicians.…”

Section: Health Status After Hct F Bernard Et Almentioning

confidence: 84%

Health status of childhood leukemia survivors who received hematopoietic cell transplantation after BU or TBI: an LEA study

Bernard

Auquier

Herrmann

et al. 2014

The purpose of this multicenter study was to compare the long-term impact of a preparative regimen with either BUBU or TBI on health status and quality of life (QoL) in childhood acute leukemia survivors treated with hematopoietic SCT (HSCT). Two-hundred and forty patients were included. Sixty-six had received BU, while 174 had received TBI. Median follow-up from HSCT was 10.1 years. Multivariate analyses were performed to assess the occurrence of late effects according to treatment. QoL was assessed in 130 adults using SF-36 questionnaires. Patients developed fewer late complications after BU (2.35 vs 3.01, P ¼ 0.03) while the risk to present with at least one complication was equivalent in both groups (87.9% after BU and 93.1% after TBI, P ¼ 0.66). Detailed multivariate analyses revealed a lower risk of height growth failure (OR ¼ 0.2), cataract (OR ¼ 0.1) and iron overload (OR ¼ 0.2) after BU, and an increased risk of overweight (OR ¼ 3.9) and alopecia (OR ¼ 11.2). SF-36 mental and physical composite scores were similar in both treatment groups and proved significantly lower than French norms. Late effects induced by BU might differ from those experienced after TBI. Although less frequent, they are still of considerable importance and may affect patients' QoL.

“…The persistence of a lower than normal BMI after TBI differs from the data observed in patients given fractionated cranial irradiation, particularly for leukemia, whose BMI is frequently increased. 16,17 This may be due to differing effects of TBI and fractionated cranial irradiation on the hypothalamicpituitary region, and/or to the irradiation of adipose tissue during TBI. The possible effect of a decreased BMI on growth rate and on plasma IGF I 3 and, to our knowledge, the absence of reported data on plasma leptin concentrations and their relationship to BMI and the GH peak after BMT, prompted us to evaluate the BMI and leptin concentrations according to the conditioning protocol.…”

Section: Discussionmentioning

confidence: 99%

Changes in height, weight and plasma leptin after bone marrow transplantation

Couto-Silva

Trivin

Esperou

et al. 2000

Summary:Short stature can be a severe side-effect of bone marrow transplantation (BMT). Because of the effect of weight changes on growth rate and on plasma insulin-like growth factor (IGF I), we analyzed changes in height and body mass index (BMI) in 53 patients given BMT. Group 1 (n = 22) was given 12 Gy total body irradiation (TBI) as six fractions, group 2 (n = 14) 10 Gy TBI (one dose), group 3 (n = 8) 6 Gy total lymphoid irradiation (one dose), and group 4 (n = 9) chemotherapy alone. At the first evaluation, 13/36 patients in groups 1 and 2 had low growth hormone (GH) peaks after stimulation. The mean plasma IGF I concentrations (z score) were similar in groups 1 (−2.9 ± 0.3) and 2 (−2.5 ± 0.3), and in groups 3 (−1.4 ± 0.3) and 4 (−1.4 ± 0.7), but those of group 1 were lower than those of groups 3 (P Ͻ 0.01) and 4 (P Ͻ 0.05), and those of group 2 than those of group 3 (P Ͻ 0.05). BMI during the 5 years after BMT did not change in groups 1 and 2, decreased in group 3, and increased in group 4. However, these changes were not significant. Most of the patients given TBI had BMI below the mean at 2 (66%) and 5 (57%) years later. Their BMI and leptin concentrations correlated positively with each other (P = 0.005), and negatively with GH peak (P = 0.02 for BMI and 0.007 for leptin). In conclusion, this study suggests that TBI actually decreases GH secretion and is followed by a persistent low BMI. The negative relationship between GH peak and leptin may indicate that both are markers of a TBIinduced hypothalamic-pituitary lesion. Bone Marrow Transplantation (2000) 26, 1205-1210. Keywords: bone marrow transplantation; body irradiation; body mass index; growth; growth hormone; leptin Short stature can be a severe side-effect of bone marrow transplantation (BMT). It may be caused by the initial disease and its treatment before BMT, by the conditioning protocol used for BMT, particularly the irradiation, by the complications of the BMT, and/or by the long-term corticosteroid therapy required to treat these complications. The irradiation may cause short stature in two ways: in patients given total body irradiation (TBI), hypothalamic-pituitary irradiation may decrease the secretion of growth hormone (GH); patients given TBI or total lymphoid irradiation (TLI) may suffer from bone lesions. 1 These lesions may be responsible for resistance to insulin-like growth factor I (IGF I), the secretion of which depends on GH and nutritional state, and a poor growth response to GH therapy. 2 The fall in weight following TBI in some patients, the effect of weight changes on growth rate and plasma IGF I, 3 and the very short adult height in many patients given TBI have prompted us to analyze the factors influencing changes in height and body mass index (BMI). We have done this by comparing patients given different conditioning protocols for BMT. Our aims were to determine if TBI actually decreases GH secretion, and if there is any relationship between the conditioning protocol and changes in BMI and plasma leptin concentrations. M...