ESPE Abstracts (2015) 84 P-2-282

Total-Body Irradiation is a Major Risk Factor for Young Adult Onset Diabetes Mellitus and Hyperlipidemia in Childhood Cancer Survivors after Hematopoietic Stem Cell Transplantation

Ryuichi Nakagawa, Atsumi Tsuji, Yuki Aoki, Keisuke Nakajima, Akito Sutani, Yuichi Miyakawa, Kei Takasawa, Daisuke Tomizawa, Masatoshi Takagi, Kenichi Kashimada & Tomohiro Morio

Tokyo Medical and Dental University, Bunkyo-ward, Tokyo, Japan

Background: Haematopoietic stem cell transplantation (HSCT) is a risk factor for young adult onset diabetes mellitus (DM) and hyperlipidaemia (HL) as late effects, especially the use of total-body irradiation (TBI). In order to investigate the clinical details, we retrospectively analysed the post-HSCT patients in our institution that required treatment for DM and/or HL.

Results: From 1983 to 2012, 24 children received HSCT in our hospital because of haematological malignancy and were followed up continuously to date. Among 24 patients, ten patients were conditioned with TBI; all the patients who developed DM and/or HL used TBI conditioning regimen. Four and five patients developed DM and HL, respectively, and four developed both. The prevalence of DM and HL in patients with TBI was 40 and 50% respectively, and Fisher’s exact test revealed TBI significantly associated with DM (P=0.035) and HL (P=0.012). The mean age at TBI of DM and non-DM patients was 2.0 (1.8–2.8) and 11.0 years (7.5–13.0) respectively, suggesting that TBI for younger children is associated with risk of DM (P=0.01). We also examined other clinical backgrounds, including the type of disease (acute lymphoblastic leukaemia (ALL) or non-ALL), the cumulative dosage of prednisolone, BMI at the onset of DM or HL, and GVHD prophylaxis with tacrolimus. However, any of these were not relevant. The generalised linear model confirmed that TBI was an independent risk factor for DM and HL.

Conclusion: Our data suggests that TBI is a risk factor for DM and HL, and younger age at TBI increases a risk for DM. The prevalence of DM and HL among patients received HSCT was higher than previously reported. This study showed that DM and HL is major late effects of TBI, and they should be taken into account for selecting the conditioning regimens for transplanting patients with haematological malignancies.