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. 2013 Sep;30(3):290-9.
doi: 10.4274/Tjh.2012.0094. Epub 2013 Sep 5.

Endocrinological and cardiological late effects among survivors of childhood acute lymphoblastic leukemia

Pakize Karakaya  1 , Sebnem Yılmaz  2 , Ozlem Tüfekçi  2 , Mustafa Kır  3 , Ece Böber  4 , Gülersu Irken  2 , Hale Oren  2
Affiliations

Endocrinological and cardiological late effects among survivors of childhood acute lymphoblastic leukemia

Pakize Karakaya et al. Turk J Haematol. 2013 Sep.

Abstract
in English, Turkish

Objective: Survival rates for childhood acute lymphoblastic leukemia (ALL) have significantly improved and late effects of therapy have been important in the follow-up of survivors. The objective of this study is to identify the endocrinological and cardiological late effects of ALL patients treated in our pediatric hematology unit.

Materials and methods: Patients treated for ALL with BFM protocols after at least 5 years of diagnosis and not relapsed were included in the study. Endocrinological late effects (growth failure, obesity, insulin resistance, dyslipidemia, thyroid gland disorders, osteopenia/osteoporosis, and pubertal disorders) and cardiological late effects were evaluated. The study group was evaluated with anthropometric measurements, body mass index, and laboratory testing of fasting glucose, insulin, serum lipids, thyroid functions, and bone mineral densities. Echocardiography and pulsed wave Doppler imaging were performed for analysis of cardiac functions.

Results: Of the 38 ALL survivors, at least 1 adverse event occurred in 23 (60%), with 8 of them (21%) having multiple problems. Six (16%) of the survivors were obese and 8 (21%) of them were overweight. Subjects who were overweight or obese at the time of diagnosis were more likely to be overweight or obese at last follow-up. Obesity was more frequently determined in patients who were younger than 6 years of age at the time of diagnosis. Insulin resistance was observed in 8 (21%) subjects. Insulin resistance was more frequently seen in subjects who had family history of type 2 diabetes mellitus. Hyperlipidemia was detected in 8 (21%) patients. Hypothyroidism or premature thelarche were detected in 2 children. Two survivors had osteopenia. Cardiovascular abnormalities occurred in one of the subjects with hypertension and cardiac diastolic dysfunction.

Conclusion: We point out the necessity of follow-up of these patients for endocrinological and cardiological late effects, since at least one adverse event occurred in most of our cases.

Conflict of interest: None declared.

Amaç: Akut lenfoblastik lösemili (ALL) çocuklarda sağkalım oranı belirgin düzelmiş ve izlemlerde geç yan etkiler açısından değerlendirilmeleri önemli hale gelmiştir. Bu çalışmanın amacı çocuk hematoloji kliniğimizde tedavisi tamamlanan akut lösemi olgularında uzun dönemde gelişebilecek endokrinolojik ve kardiyolojik geç etkilerin belirlenmesidir. Gereç ve Yöntemler: Lösemi tanısı aldığı tarihten itibaren en az beş yıl geçmiş, relaps gelişmemiş ve BFM protokolleri ile tedavi edilmiş hastalar endokrinolojik geç etkiler (boy kısalığı, obezite, insülin direnci, dislipidemi, tiroid hastalığı, osteopeni/osteoporoz, puberte sorunları) ve kardiyolojik geç etkiler açısından değerlendirildi. Çalışma grubunda antropometrik ölçümler, vücut kitle indeksi, açlık kan şekeri, insülin, serum lipid ve tiroid fonksiyon testleri ve kemik mineral dansiteleri araştırıldı. Kardiyak fonksiyonların analizinde ekokardiyografi ve pulsed Doppler görüntüleme kullanıldı.Bulgular: 38 olgudan 23’ünde (%60) en az bir, 8 olguda (%21) ise birden fazla geç etki olduğu görüldü. Altı olgunun (%16) fazla kilolu, 8’inin (%21) obez olduğu belirlendi. Tanı anında fazla kilolu ya da obez olanlarda ve tedavi bitiminde fazla kilolu ya da obez olanlarda son değerlendirmede obezite daha yüksek orandaydı. Tanı anında altı yaşın altında olanlarda obezite daha fazlaydı. Sekiz olguda (%21) insülin direnci vardı. Obez ya da fazla kilolu olanlarda ve ailede tip 2 DM öyküsü bulunanlarda insülin direnci daha yüksek oranda bulundu. Sekiz olguda (%21) hiperlipidemi saptandı. Hipotiroidi veya prematür telarş birer olguda, osteopeni 2 olguda görüldü. Kardiyolojik geç etki olarak bir olguda hipertansiyon ve hafif diastolik disfonksiyon olduğu belirlendi. Sonuç: Olguların çoğunda en az bir geç yan etki gözlendiğinden, bu çocukların endokrinolojik ve kardiyolojik geç etkiler açısından takip edilmelerinin gerekli olduğu ortaya çıkmaktadır .

Keywords: Cardiotoxicity; Chemotherapy; Endocrinology; Late effects; Leukemia; childhood.

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