Contributions
Abstract: PB2366
Type: Publication Only
Background
Metabolic disorders have been increasingly recognized in childhood cancer survivors. Dyslipidemia, glucose intolerance, hyperinsulinism and insulin resistance may play a role in the development of metabolic syndrome and later cardiovascular disease in these patients. Contributing factors to metabolic disturbances include cancer type and treatment, associated hormonal disorders, disturbed energy intake and/or physical inactivity as well as family history of metabolic disorders and obesity.
Aims
To assess the metabolic profile of children and adolescents after completing their treatment for hematologic malignancies.
Methods
Children and adolescents with hematologic malignancies (2 groups: leukemia or lymphoma), at least 6 months post-treatment, underwent measurement of height and weight, Tanner staging for sexual maturity, liver ultrasonography and fasting blood lipid profile assessment for cholesterol (C), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoproteins A1 (apoA1) and B (apoB), lipoprotein a (Lpa) and uric acid (UA). Body mass index (BMI) and homeostatic model assessment for insulin resistance (HOMA-IR) were calculated for each patient.
Results
A total of 30 patients, 18 with acute lymphoblastic or acute myelogenous leukemia (15 and 3, respectively), (mean age ± SD; 12.7 ± 3.8 years) and 12 with Hodgkin or non-Hodgkin lymphoma (10 and 2, respectively) (mean age ± SD, 14.5 ± 3.3 years) participated in the study. Patients had completed treatment for leukemia before 21.6 ± 13.6 months and for lymphoma before 19.3 ± 11.5 months. Among patients with leukemia 23.5% had normal weight and 76.5% were overweight or obese, whereas among patients with lymphoma, 58.3% had normal weight and 41.7% were overweight or obese. Serum concentrations (mean ± SD) of lipids in patients with leukemia were C 168.5 ± 32.1 mg/dl, LDL 95.6 ± 26.8 mg/dl, HDL 57.5 ± 13 mg/dl, TG 76.9 ± 30.5 mg/dl, apoA1 148.5 ± 29.2 mg/dl, apoB 86.9 ± 21.7 mg/dl, UA 4.8 ± 1.7 mg/dl and for Lpa median (interquartile range): 4.7 (37.5) mg/dl. Respective concentrations for patients with lymphoma were C 166 ± 27.6 mg/dl, LDL 89.3 ± 21.4 mg/dl, HDL 63.3 ± 14.7 mg/dl, TG 67.1 ± 26 mg/dl, apoA1 127.2 ± 45.4 mg/dl, apoB 78.0 ± 11.6 mg/dl, UA 4.5 ± 1.5 mg/dl and Lpa 2.9 (6.4) mg/dl. HOMA-IR (mean ± SD) was 2.1 ± 1.5 or 3.1 ± 1.9, for patients with leukemia or lymphoma respectively. There was no statistically significant difference in the metabolic profile between the 2 groups. Among patients with leukemia, serum TG were significantly higher (P=0.011) in those with fatty infiltration of liver (100.8 ± 32 mg/dl) than patients without fatty liver (63.8 ± 21.2 mg/dl). In patients with lymphoma, UA concentrations and HOMA-IR were higher (P=0.042 and P=0.031 respectively) in overweight or obese patients (5.5 ± 1.4 mg/dl and 4.4 ± 1.6 respectively) than in normal weight patients (3.8 ± 1.2 mg/dl and 1.5 ± 0.2 respectively). There were no statistically significant differences in the lipid profile between genders for both groups.
Conclusion
Serum TG were associated with fatty infiltration of the liver in patients with leukemia whereas UA and HOMA-IR were associated with BMI-category in patients with lymphoma. Larger studies are needed to fully elucidate the metabolic disturbances in young survivors of hematologic malignancies.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Late effects, Leukemia, lymphoma, Metabolic syndrome
Abstract: PB2366
Type: Publication Only
Background
Metabolic disorders have been increasingly recognized in childhood cancer survivors. Dyslipidemia, glucose intolerance, hyperinsulinism and insulin resistance may play a role in the development of metabolic syndrome and later cardiovascular disease in these patients. Contributing factors to metabolic disturbances include cancer type and treatment, associated hormonal disorders, disturbed energy intake and/or physical inactivity as well as family history of metabolic disorders and obesity.
Aims
To assess the metabolic profile of children and adolescents after completing their treatment for hematologic malignancies.
Methods
Children and adolescents with hematologic malignancies (2 groups: leukemia or lymphoma), at least 6 months post-treatment, underwent measurement of height and weight, Tanner staging for sexual maturity, liver ultrasonography and fasting blood lipid profile assessment for cholesterol (C), triglycerides (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), apolipoproteins A1 (apoA1) and B (apoB), lipoprotein a (Lpa) and uric acid (UA). Body mass index (BMI) and homeostatic model assessment for insulin resistance (HOMA-IR) were calculated for each patient.
Results
A total of 30 patients, 18 with acute lymphoblastic or acute myelogenous leukemia (15 and 3, respectively), (mean age ± SD; 12.7 ± 3.8 years) and 12 with Hodgkin or non-Hodgkin lymphoma (10 and 2, respectively) (mean age ± SD, 14.5 ± 3.3 years) participated in the study. Patients had completed treatment for leukemia before 21.6 ± 13.6 months and for lymphoma before 19.3 ± 11.5 months. Among patients with leukemia 23.5% had normal weight and 76.5% were overweight or obese, whereas among patients with lymphoma, 58.3% had normal weight and 41.7% were overweight or obese. Serum concentrations (mean ± SD) of lipids in patients with leukemia were C 168.5 ± 32.1 mg/dl, LDL 95.6 ± 26.8 mg/dl, HDL 57.5 ± 13 mg/dl, TG 76.9 ± 30.5 mg/dl, apoA1 148.5 ± 29.2 mg/dl, apoB 86.9 ± 21.7 mg/dl, UA 4.8 ± 1.7 mg/dl and for Lpa median (interquartile range): 4.7 (37.5) mg/dl. Respective concentrations for patients with lymphoma were C 166 ± 27.6 mg/dl, LDL 89.3 ± 21.4 mg/dl, HDL 63.3 ± 14.7 mg/dl, TG 67.1 ± 26 mg/dl, apoA1 127.2 ± 45.4 mg/dl, apoB 78.0 ± 11.6 mg/dl, UA 4.5 ± 1.5 mg/dl and Lpa 2.9 (6.4) mg/dl. HOMA-IR (mean ± SD) was 2.1 ± 1.5 or 3.1 ± 1.9, for patients with leukemia or lymphoma respectively. There was no statistically significant difference in the metabolic profile between the 2 groups. Among patients with leukemia, serum TG were significantly higher (P=0.011) in those with fatty infiltration of liver (100.8 ± 32 mg/dl) than patients without fatty liver (63.8 ± 21.2 mg/dl). In patients with lymphoma, UA concentrations and HOMA-IR were higher (P=0.042 and P=0.031 respectively) in overweight or obese patients (5.5 ± 1.4 mg/dl and 4.4 ± 1.6 respectively) than in normal weight patients (3.8 ± 1.2 mg/dl and 1.5 ± 0.2 respectively). There were no statistically significant differences in the lipid profile between genders for both groups.
Conclusion
Serum TG were associated with fatty infiltration of the liver in patients with leukemia whereas UA and HOMA-IR were associated with BMI-category in patients with lymphoma. Larger studies are needed to fully elucidate the metabolic disturbances in young survivors of hematologic malignancies.
Session topic: 36. Quality of life, palliative care, ethics and health economics
Keyword(s): Late effects, Leukemia, lymphoma, Metabolic syndrome