Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy.

Esbenshade, Adam J.; Simmons, Jill H.; Koyama, Toshihiro; Koehler, Elizabeth; Lindell, Robert B.; Friedman, D. L.

doi:10.1200/jco.2011.29.15_suppl.e19611

Cited by 6 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Until now, most studies investigating body composition had been conducted in ALL and lymphoma survivors and have shown a wide variation of obesity, even up to about 50%. The authors observed higher fat mass and lower lean mass in these patients after treatment completion compared with healthy subjects . Determining body composition and its association with circulating adipokines could be of clinical importance.…”

Section: Discussionmentioning

confidence: 89%

“…However, the literature data on the relations between body composition parameters and serum levels of adipokines in childhood cancer survivors are still scare and the results are ambiguous. Generally, authors reported an increase in leptin (positively correlated with BMI z‐score) and a decrease in adiponectin (inversely correlated with BMI z‐score) levels in patients with acute lymphoblastic leukemia after therapy completion . They suggested that corticosteroid therapy, as well as cranial irradiation used in patients with ALL causes anthropometric and metabolic changes.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Body composition parameters and adipokines levels in relation to bone mineral density in patients with malignant bone tumors after treatment

Ambroszkiewicz¹,

Chełchowska²,

Szamotulska

et al. 2014

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Body composition parameters and adipokines levels in relation to bone mineral density in patients with malignant bone tumors after treatment

Ambroszkiewicz¹,

Chełchowska²,

Szamotulska

et al. 2014

Pediatric Blood & Cancer

View full text Add to dashboard Cite

show abstract

“…Author found that in these patients over the first year of ALL maintenance therapy demonstrated that components of the metabolic syndrome significantly worsen over time. Preventive interventions limiting increases in BMI and insulin resistance during maintenance therapy should be targeted during this time period to avoid long-term morbidity associated with the metabolic syndrome in long-term survivors [15]. Al-Tawil MM et al described the studies associating chronic hepatitis C virus (HCV) infection with lipid profile and hepatic steatosis in leukemia or lymphoma cured children.…”

Section: Discussionmentioning

confidence: 99%

The evaluation of nutritional status disorders as a state of overweight and hyperlipidemia in children with cancer

Tejza

Kurylak

Grześk

et al. 2015

MBS

View full text Add to dashboard Cite

A i m o f s t u d y. The assessment of nutritional status with a special attention towards overweight by anthropometric measurements and biochemical parameters of lipids in children with cancer. M a t e r i a l a n d m e t h o d s. In a retrospective group data of 122 patients' treatment history were analyzed. The patients were treated in our hospital in previous years and their weight and height were studied. In a prospective group 62 newly diagnosed children with cancer were examined. The additional anthropometric measurements were included in the research like skinfolds thickness and middle arm circumference and biochemical lipids date were taken. The data were analyzed three times: at the diagnosis, during the oncological treatment and after the intensive chemotherapy.

show abstract

“…48,49 A group of American investigators has shown that preventive therapeutic interventions limiting the increase in BMI and insulin resistance may be particularly important during maintenance therapy. 50 These therapeutic interventions will however require more expensive prospective studies for accurate evaluation.…”

Section: Number Of Cases (%) 95% CImentioning

confidence: 99%

Metabolic Syndrome in Long-Term Survivors of Childhood Acute Leukemia Treated without Hematopoietic Stem Cell Transplantation: An L.E.Α. Study

Saultier

Auquier

Bertrand

et al. 2016

Blood

View full text Add to dashboard Cite

INTRODUCTION Acute leukemia (AL) accounts for one third of childhood cancers. Cardiovascular conditions are serious long-term complications of childhood AL. However, few studies have investigated the risk of metabolic syndrome (MetS), a known predictor of cardiovascular disease, in patients treated without hematopoietic stem cell transplantation (HSCT). We describe the overall and age-specific prevalence, and risk factors for MetS and its components in the L.E.A. French cohort of childhood AL survivors treated without HSCT. METHODS L.E.A. is a long-term follow-up program involving all childhood AL survivors treated in the French participating centers since 1980 (clinicaltrials.gov identifier: NCT 01756599). MetS was defined according to the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATPIII) criteria revised in 2005. RESULTS The study included 650 adult patients. The mean age at evaluation was 24.2 years and the mean follow-up after leukemia diagnosis was 16.0 years. Central nervous system (CNS) irradiation was performed in 18.0% of patients (n=117). The prevalence of MetS was 6.9% (95% CI 5.1-9.2). The age-specific cumulative prevalence at 20, 25, 30 and 35 years of age was 1.3%, 6.1%, 10.8% and 22.4%, respectively, as shown in the Figure. The prevalence of decreased HDL-cholesterol, increased triglycerides, increased fasting glucose, increased blood pressure and increased abdominal circumference was 26.8%, 11.7%, 5.8%, 36.7% and 16.7%, respectively. The risk factors significantly associated with metabolic syndrome in the multivariate analysis were male gender, older age at last evaluation and higher body mass index at diagnosis, as shown in the Table. Cumulative steroid dose was not a significant risk factor. CNS-irradiated and non-irradiated patients exhibited different patterns of metabolic abnormalities, with more frequent abdominal obesity in irradiated patients and more frequent hypertension in non-irradiated patients. DISCUSSION Our study aimed to precisely describe the overall and age-specific prevalence, and risk factors of MetS in a large cohort of childhood AL survivors treated without HSCT. Notably, the subgroup treated with chemotherapy alone is one of the largest ever published, which is of particular interest as current protocols include very limited CNS irradiation indications. The prevalence of MetS was approximately two-fold higher than that observed in the adult French general population under 40 years of age. Moreover, the prevalence of MetS was found to increase markedly with age. An increased BMI at diagnosis was a risk factor for MetS. Children with an elevated BMI at diagnosis may have a genetic predisposition to metabolic disturbances or a socio-familial environment that renders them more vulnerable to metabolic complications. CNS irradiation was not found to be a risk factor for MetS. In the literature however, brain irradiation has been frequently reported as a risk factor for MetS. This variation with our study can probably be explained in part by the observation that our irradiated patients displayed a lower risk of elevated blood pressure along with a greater risk of increased abdominal circumference. The irradiated patients may therefore have a different metabolic risk profile compared with the non-irradiated patients, thereby suggesting varying mechanisms of pathogenesis. The results of our study confirm the need for early and prolonged follow-up of adult survivors of childhood AL even when treated without HSCT and without CNS irradiation. This prerequisite could enable both early detection of metabolic abnormalities and implementation of appropriate therapeutic procedures to reduce the morbidity and mortality associated with cardiovascular complications in such patients. Table. Multivariate analysis of potential risk factors for the metabolic syndrome OR: odds ratio; CI: confidence interval; BMI: body mass index; CNS: central nervous system; † OR per each additional year of follow-up; ‡ OR per each additional z-score unit; *significant values (p < 0.05) Table. Multivariate analysis of potential risk factors for the metabolic syndrome. / OR: odds ratio; CI: confidence interval; BMI: body mass index; CNS: central nervous system; † OR per each additional year of follow-up; ‡ OR per each additional z-score unit; *significant values (p < 0.05) Figure. Age-specific cumulative prevalence of the metabolic syndrome Figure. Age-specific cumulative prevalence of the metabolic syndrome Disclosures No relevant conflicts of interest to declare.

show abstract

Obesity and insulin resistance in pediatric acute lymphoblastic leukemia worsens during maintenance therapy.

Abstract: Background-Pediatric acute lymphoblastic leukemia (ALL) survivors are at increased risk for the metabolic syndrome (MS). To establish the trajectory of development during active treatment, we followed patients longitudinally over the first year of maintenance therapy.

Cited by 6 publications

References 19 publications

Body composition parameters and adipokines levels in relation to bone mineral density in patients with malignant bone tumors after treatment

Body composition parameters and adipokines levels in relation to bone mineral density in patients with malignant bone tumors after treatment

The evaluation of nutritional status disorders as a state of overweight and hyperlipidemia in children with cancer

Metabolic Syndrome in Long-Term Survivors of Childhood Acute Leukemia Treated without Hematopoietic Stem Cell Transplantation: An L.E.Α. Study

Contact Info

Product

Resources

About