Identifying Cardiovascular Risk in Survivors of Childhood Leukaemia Treated with Haematopoietic Stem Cell Transplantation and Total Body Irradiation

Abstract

Background: Survivors of childhood with haematopoietic stem cell transplantation and total body irradiation (HSCT/TBI) have an increased cardiometabolic risk without overt obesity. Aim: To describe cardiometabolic risk in HSCT/TBI survivors and identify anthropometric measurements of adiposity representative of cardiometabolic risks in HSCT/TBI survivors. Method: Childhood leukaemia survivors treated with HSCT/TBI (n = 21, 11 males) were compared with chemotherapy-only (n = 31) and obese non-leukaemic controls (n = 30). All subjects (16–26 years) had blood pressure and auxological measurements (body mass index, waist and hip circumferences) and blood tests (triglycerides, high-density lipoprotein [HDL], and oral glucose tolerance tests). Central adiposity was defined as either increased waist circumference (WC), waist-to-height ratio (WHtR) (>0.5), or waist-to-hip ratio (WHR) (males >0.9, females >0.85). Results: HSCT/TBI survivors showed higher prevalence of hypertriglyceridaemia than both comparison groups and higher prevalence of reduced HDL compared to the chemotherapy-only group. The WHR reported a higher prevalence of increased adiposity in HSCT/TBI survivors compared with WC and WHtR, but such differences were not observed in the other groups. In the HSCT survivors, WHR had the highest number of significant associations with metabolic risk factors, and metabolic risks worsen with time elapsed since primary treatment. Conclusions: HSCT/TBI survivors have high cardiometabolic risk that is not sufficiently reflected by WC alone. WHR is a useful surrogate marker for increased cardiometabolic risk in HSCT/TBI survivors.

Body composition after allogeneic haematopoietic cell transplantation/total body irradiation in children and young people: a restricted systematic review

“…A final total of 20 papers were included-seven controlled studies [1,10,[18][19][20][21][22], five uncontrolled studies [23][24][25][26][27] and eight case reports/series [28][29][30][31][32][33][34][35]. Only one study included an intervention [23].…”

“…High waist-to-hip ratio was associated with features of metabolic syndrome in one study [22], and visceral fat % was associated with insulin resistance in another [1].…”

“…All three studies which measured adipose tissue function found significant differences for HSCT + TBI groups compared to leukaemic controls and some to non-leukaemic controls. Compared to leukaemic controls, adiponectin was lower, leptin higher, triglycerides higher and high-density lipoprotein (HDL) lower [10,18,22]. The only difference compared to non-leukaemic controls (obese) was for raised triglycerides [22].…”

“…Nysom et al found significantly lower BMI compared to healthy controls [20]. Wei et al also found significantly lower BMI and fat mass index, but this was compared to obese controls [10,22]. Three studies found significantly higher body fat: body fat % compared to short stature controls [19] and healthy controls [20] and whole body fat mass z score compared to reference controls [1].…”

“…Most of the studies which measured central adiposity found significantly higher central adiposity for HSCT + TBI groups compared to leukaemic controls and non-leukaemic (obese/ short stature/healthy) controls. Evidence from four studies found significant differences for lower waist-to-hip ratios and higher android-gynoid fat ratios compared to leukaemic controls and for higher waist circumference/waist-height ratio, greater trunk fat % and visceral fat %, compared to nonobese non-leukaemic controls [1,19,22,118]. One study found evidence of significant differences for lower waist circumference/waist-height ratio, higher visceral fat % and higher visceral fat to total/subcutaneous fat ratios compared to obese non-leukaemic controls [10].…”