Introduction: Well-known long-term complications of alloHSCT in childhood include endocrine system damage and secondary malignancies. In addition, adults surviving childhood alloHSCT are at risk of cardiovascular (CV) and metabolic disturbances. Long-term data of physical fitness in correlation with metabolic status are scarce in this particular group.
Objective/Patients and Methods: Cross-sectional investigation of exercise performance by cardiopulmonary exercise testing (CPET) and metabolic parameters in boys and girls (age 16-25 years), who underwent alloHSCT for a hematological malignancy in childhood, in comparison to healthy peers. Maximal oxygen consumption (VO2peak), maximal load (PPeak), exercise duration (time), ventilatory anaerobic threshold (VAT), leptin/adiponectin ratio (L/A ratio), HOMA-IR, whole body fat and lean mass were determined. After testing for normality, data were compared using parametric (unpaired t-Test) or non-parametric (Mann-Whitney U-Test) tests. Pearson correlation test was used to evaluate correlations between metabolic and physical fitness parameters.
Results: Twenty-one patients (11 males, 10 females, age 20.3±3.3yrs, weight 58.4±9.6kg, length 166.9±6.8cm, BMI 21.0±3.3) and 21 controls (11 males, age 19.4±3.0yrs, weight 61.8±9.0kg, length 169.0±6.1cm, BMI 21.5±2.7) participated. In the patient group, mean age at time of alloHSCT was 9.2±4,91years. Indications for alloHSCT were ALL (n=15), AML (n=2), CML (2), ALCL (n=1) and MDS (n=1). Maximal heart rate was not different in both groups (183.6±9.8bpm vs. 187.8±19.6bpm, NS). AlloHSCT patients had lower maximal oxygen consumption (VO2peak, 32.7±9ml/kg/min vs. 38.8±6 kg/min, p<0.05), shorter exercise duration (9.0±2.5min vs. 13.1±2.8min, p<0.001), lower maximal load (%PPeak 82.5±47.3 vs. 112.6±34.6%, p<0.001) and different aerobic threshold (66.9±17.4% vs. 50.2±9.2%, p=0.001). HSCT-patients had higher L/A ratio (4.24±5.91 vs. 1.55±1.22, p<0.05), HOMA-IR (2.63±1.69 vs. 1.78±046, p<0.05), whole body fat mass (16.360±7.294kg vs. 14.206±5.496kg, p<0.01) and lower whole body lean mass (41.270±9.430kg vs. 46.664±6.430kg, p<0.05). L/A ratio, whole body fat mass and whole body fat percentage were negatively correlated with VO2peak (ρ -0.57, p<0.01; ρ -0.66, p=0.001 and ρ -0.71, p=0.001, respectively). No correlation between HOMA-IR and VO2peak was withheld.
Conclusions: Young adults after HSCT have lower maximal exercise performance and a less favorable metabolic profile in comparison with healthy children. Leptin/adiponectin ratio, whole body fat mass and whole body fat percentage are negatively correlated with physical fitness, stressing the importance of healthy lifestyle promotion and physical rehabilitation in this patient population.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology