Background: Hematopoietic stem cell transplantation (HSCT) recipients are at risk of endocrine complications as a result of chemotherapy and radiation therapy. Development of diabetes mellitus (DM) after HSCT is less frequently reported compared with other complications.
Objective and hypotheses: We investigated clinical features of newly diagnosed DM after HSCT for treatment of childhood leukemia.
Method: Between April 1999 and March 2013, total 112 patients (63 males and 49 females) were visited the Clinic of Pediatric Endocrinology for routine follow-up check after HSCT for leukemia. Among them, four patients developed DM (three males and one female). We retrospectively reviewed medical charts including laboratory findings.
Results: Three patients were diagnosed as acute lymphoblastic leukemia who received total body irradiation and chemotherapy. The other one patient diagnosed as acute myeloblastic leukemia received only chemotherapy for conditioning. The mean age at HSCT was 7.75±4.21 years. All four patients developed chronic graft-vs-host disease (GVHD) and treated with steroid. The mean age at diagnosis of DM was 16.25±1.48 years and the time interval between HSCT and DM was 8.5±4.2 years. Three patients showed obesity depend on BMI (>95th percentile for sex and age). No one showed antibodies related with pancreatic β-cell. The mean fasting insulin levels at diagnosis were 13.24±9.17 μIU/ml and the mean homeostasis model assessment indexes of patients was 4.5±2.0. Three patients who showed obesity were treated with metformin only or metformin and insulin injection, and the other one was treated with insulin injection only. After the treatment, the diabetic control of all patients was improved.
Conclusion: GVHD, long-term steroid treatment and insulin resistance seem to be close related to develop of DM after HSCT for treatment of childhood leukemia.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology