ESPE Abstracts (2015) 84 P-2-380

Fat

Insulin Resistance and Abnormal Glucose Tolerance After Paediatric Hematopoietic Stem Cell Transplantation in Blood Cancer Survivors

Sara Cicconea,b, Carla Bizzarria, Rita Maria Pintoc, Letizia Pomponia Bresciac, Franco Locatellic,d & Marco Cappaa

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aUnit of Endocrinology and Diabetes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy; bUnit of Pediatrics, S. Anna University Hospital, Ferrara, Italy; cDepartment of Pediatric Hematology and Oncology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy; dDepartment of Pediatric Science, University of Pavia, Pavia, Italy


Background: Patients who had undergone hematopoietic stem cell transplantation (HSCT) during childhood have been reported to have a higher risk of early metabolic syndrome (MS) and diabetes mellitus (DM) with a consequent increased risk of cardiovascular disease. Previous studies reported a cumulative incidence of abnormal glucose tolerance of 11.6% at 5 years from HSCT and of 69.3% at 10 years and a prevalence of MS of 32% at 4 years from HSCT.

Objective and hypotheses: Assess the prevalence and potential risk factors for MS and abnormal glucose tolerance in young patients who underwent pediatric HSCT.

Method: This is a single-centre, prospective, descriptive, and cross-sectional study. Clinical and laboratory data including oral glucose tolerance test (OGTT) of 45 blood cancer survivors treated with HSCT (mean age: 13.9±4.8 years) and 95 matched healthy controls (mean age: 13.8±4.9 years) were analysed.

Results: *7/45 patients (15.5%) showed impaired glucose tolerance (IGT) or DM, 1/45 (2.2%) was obese and none fulfilled the criteria for MS. Abdominal adiposity (waist-to-height ratio >0.5) was more common in IGT/DM patients, in comparison with both normal glucose tolerance patients (NGT) and controls. Analysis of insulin resistance/sensitivity indexes suggested an insulin-resistant state in HSCT survivors (both NGT and IGT/DM patients) compared to controls. In IGT/DM patients, the use of total body irradiation (TBI) during the conditioning regimen was significantly more common, and the time elapsed from HSCT was significantly longer than in NGT patients.

Conclusion: Blood cancer survivors treated with HSCT may develop insulin resistance early after transplantation, showing redistribution of fat tissue with central fat accumulation despite a normal BMI. The main factors associated with increased metabolic risk are TBI and time from HSCT. Evaluation of MS and glucose tolerance should be part of hormonal follow up, which should be routinely proposed to these patients in order to prevent cardiovascular disorders.

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