Anti-metabolic syndrome efforts needed for young ALL survivors

Mar 5 2013

By Helen Albert, Senior medwireNews Reporter

Children with acute lymphoblastic leukemia (ALL) are at risk for developing the metabolic syndrome during maintenance therapy, suggest study findings.

"Preventive interventions limiting increases in BMI and insulin resistance during maintenance therapy should be targeted during this time period to avoid long-term morbidity associated with the metabolic syndrome in long-term survivors," suggest Adam Esbenshade (Vanderbilt University School of Medicine, Nashville, Tennessee, USA) and colleagues in Pediatric Blood and Cancer.

The researchers followed up 34 children (64.7% male), aged a median of 6 years, who survived ALL for the first 12 months of their maintenance therapy to assess metabolic syndrome-related features.

They found that median body mass index (BMI) z-score for the children increased significantly from 0.29 to 0.66 over the 12 months. Median fasting insulin and leptin levels also increased from 2.9 to 3.1 µU/mL and 2.5 to 3.5 ng/mL, respectively, and the percentage of children with insulin resistance increased from 3% at baseline to 24% at 12 months.

In addition, the median level of adiponectin decreased over the 12 months, from 18.0 to 14.0 µg/mL, but total and low-density lipoprotein levels were unchanged. Levels of triglycerides decreased and high-density lipoprotein cholesterol marginally increased.

Systolic and diastolic hypertension levels in the cohort were high, at 23.5% and 26.4%, respectively, but rates did not change significantly over the follow-up period.

"Children with ALL are at increased risk for metabolic abnormalities, which worsen over the course of maintenance therapy," summarize Esbenshade and team.

"Strategies that may provide benefit include nutrition and exercise interventions as well as reduction in corticosteroid exposure, the latter of which is being tested in a Children's Oncology Group study. Our findings suggest that the first year of maintenance therapy should be targeted for preventive exercise and nutrition interventions, which will support the return to a healthy lifestyle," they conclude.

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