Anthropometric changes in survivors of childhood acute lymphoblastic leukemia treated on the Italian Association of Pediatric Hematology and Oncology protocols without radiotherapy in the last two decades: preliminary data from an Italian tertiary center

Patrizia Bruzzi; Umberto Cattini; Elisa Deonette; Cano Carmen Gargiulo; Giovanni Palazzi; Lorenzo Iughetti

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ESPE Abstracts (2024) 98 RFC10.3

ESPE2024 Rapid Free Communications Multisystem Endocrine Disorders (6 abstracts)

Anthropometric changes in survivors of childhood acute lymphoblastic leukemia treated on the Italian Association of Pediatric Hematology and Oncology protocols without radiotherapy in the last two decades: preliminary data from an Italian tertiary center.

Patrizia Bruzzi ¹ , Umberto Cattini ¹ , Elisa Deonette ² , Carmen Gargiulo Cano ³ , Giovanni Palazzi ³ & Lorenzo Iughetti ⁴

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¹Pediatric Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy. ²Post-graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy. ³Pediatric Oncology Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy. ⁴Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy

Background: Previous research demonstrated that survivors of childhood acute lymphoblastic leukemia (ALL), treated on the Italian Association of Pediatric Hematology and Oncology (AIEOP) protocols without radiotherapy between 1989 and 2000, generally achieve a normal final height with a body mass index (BMI) within the normal range. Nevertheless, their height catch-up growth is not fully restored after chemotherapy and BMI increases during treatment. In females, this increase persists until the achievement of final height.

Aim: Recent ALL protocols aim at continuing increase the survival together with reducing adverse effects. Therefore, our purpose is to analyze the effect of recent AIEOP ALL protocols on long-term growth of survived children and adolescents.

Methods: We study retrospectively 98 patients (47 females) treated on AIEOP protocols without radiotherapy between 2000 and 2020 at our tertiary pediatric oncologic center. Height- and BMI-standard deviation score (SDS) are collected at diagnosis of ALL, at the end of treatment and at the latest available follow-up visit. Statistical analysis is carried out on STATISTICA (StatSoft Inc, Tulsa, OK, USA).

Results: To date, we enrolled 20 survivors (10 females) aged 7.44±3.90 years at diagnosis of ALL. Anthropometric parameters were within the normal range at diagnosis of ALL (height SDS -0.14±1.02 and BMI SDS -0.52±1.28). Height SDS did not change significantly during chemotherapy and after a follow-up of 2.40±0.87 years (-0.14±1.02 vs. -0.15±0.69 vs. -0.39±1.19 SDS, p 0.17). Meanwhile, BMI SDS increased significantly not only during treatment but also after its end (-0.52±1.28 vs. -0.04±1.30 vs. 0.47±1.39 SDS, p 0.008), especially in females (-0.76±1.37 vs. -0.21±1.43 vs. 0.59±1.31, p 0.04).

Conclusion: Even if this preliminary analysis does not comprise the total cohort, the expected improving and protective effect of the application of more recent ALL protocol on the already known risk of long-term increase of BMI in survivors has not been documented yet. If confirmed, our data support the main role of concomitant external life-style factors (e.g. loss of physical activity, impaired motor function, unhealthy diet…) in increasing the risk of overweight and obesity in ALL survivors, despite a more personalized and tailored chemotherapy. Moreover, our data point out that clinicians still need to improve in educating colleagues, families and patients in preventing these metabolic consequences and in developing specific intervention strategies, including correct dietary and lifestyle choices.