ESPE Abstracts (2019) 92 P1-350

Metabolic Risk in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia

Milena Belcheva1, Violeta Iotova2, Nataliya Usheva3, Yana Bocheva4, Ralitsa Popova5, Ruzha Pancheva6, Hristina Hristozova1, Valeriya Kaleva1


1Clinic of Pediatric Hematology and Oncology, University Hospital "St. Marina", Varna, Bulgaria. 2First Pediatric Clinic, University Hospital "St. Marina", Varna, Bulgaria. 3Department of Social Medicine and Health Care Organization, Medical University, Varna, Bulgaria. 4Central Clinical Laboratory, University Hospital "St. Marina", Medical University, Varna, Bulgaria. 5Department of Diagnostics Imaging and Radiotherapy, University Hospital "St. Marina", Varna, Bulgaria. 6Department of Hygiene and Epidemiology, Medical University, Varna, Bulgaria


The aim of this study is to evaluate the modifiable factors of metabolic risk among survivors of childhood acute lymphoblastic leukemia (ALL) treated at a single center in comparison with healthy controls.

Forty-seven long-term survivors, aged 9-32 years were compared to 35 age- and sex-matched controls. Anthropometric features and laboratory findings were assessed. The body composition was measured by Dual-energy X-ray absorptiometry (DEXA). The physical activity (PA) was assessed by questionnaires and interview.

After a median follow-up of 136 months overweight/obesity was present in 48.9% of survivors. BMI Z-score and waist circumference were significantly higher among survivors under 18 years of age (0.95±0.7 vs -0.23±0.9, P=0.001 and 78.6±8.9 cm vs 65.9±9.0 cm, P=0.001, respectively) and among males above 18 years (0.62±1.1 vs -0.50±0.7, P=0.004 and 95.5±14.8 cm vs 83.1±8.9 cm, P=0.01, respectively), compared to controls of the same age groups. Younger (under 18) survivors and older (above 18) male survivors, as well these with cranial radiotherapy of 24 Gy, had significantly higher percentage of fat and fat mass index as compared to controls. Fifty-seven percent of young women presented with normal weight obesity after treatment. At least one abnormality of the lipid panel was observed more frequently among survivors than controls (59.6% vs 25.7%, P=0.001); two and more abnormalities were more likely present in male than female survivors (32% vs 4.5%, P=0.01). The rate of metabolic syndrome differed significantly between survivors and controls (14.9% vs 0%, P<0.007). ALL survivors, especially females, were engaged in weekly sport activities about twice less frequently than controls (2.2±2.6 vs 4.0±3.4, P=0.005), fewer of them had weekly PA adequate to recommendations (44% vs 69%, P=0.03) and most had longer daily screen time (194±103 min vs 141±72 min, P=0.01).

Even at a relatively young age, survivors of childhood ALL develop an unfavorable long-term cardiovascular profile. Early identification and aggressive management of traditional risk factors in this population would reduce the overall metabolic risk.

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