Background: Secondary forms of diabetes mellitus (DM) are underdiagnosed in children and adolescents with cancer because despite the whole body of evidence that asparaginase, steroids and total body irradiation increase the risk of developing DM, risk factors are missing and asides from treatments understudied (e.g., pre-existing obesity, sex, age, ethnicity, family history of DM). The objectives of our study were to assess the incidence and associated risk factors of developing dysglycemia in children and adolescents treated for leukemia or lymphoma.
Methods: We conducted a 15-years retrospective study of pediatric patients treated for acute lymphoblastic leukemia (ALL), Hodgkins lymphoma (HL), and non-Hodgkins lymphoma (NHL) immediately at treatment initiation. We studied risk factors for DM in univariate and multivariate analyses.
Results: Our study cohort included 267 patients corresponding to 179 patients with ALL, 48 with NHL and 40 with HL. Eighteen percent of ALL patients (32/179) and 17% of NHL patients (8/48) developed DM within 2 months of treatment (for >61% of cases). Half of NHL patients and 36% of ALL patients presented impaired glucose tolerance (IGT). No DM or IGT was observed in HL patients. Multivariate analysis showed the following DM risk factors for ALL patients: overweight or obesity (OR 3.793) and pubertal onset (OR 4.269) at cancer diagnosis, steroid-resistant disease (OR 3.445) and hematopoietic stem cell transplant (HSCT) (OR 4.754). Advanced age (P < 0.001) and high-risk treatment (P = 0.002) significantly associated with DM onset, were no longer present after adjustment with other cofactors.
Conclusion: In our cohort, 18% of patients with ALL or NHL developed early-onset DM after chemotherapy/radiotherapy. Patients with ALL with increased DM risk can be readily identified by measuring BMI and puberty stage at cancer diagnosis. Also, glucose monitoring should be reinforced when patients show steroid-resistant disease and/or require HSCT.
22 Sep 2021 - 26 Sep 2021