Evaluation of endocrine late complications in childhood acute lymphoblastic leukemia survivors: A report of a single-center experience and review of the literature Akut lenfoblastik lösemili çocuklarda endokrin geç komplikasyonların değerlendirilmesi: Tek merkez deneyimi ve literatür derlemesi


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Bayram C., Yaralı N. , Fettah A., Demirel F., Tavil B., Kara A., ...More

Turkish Journal of Hematology, vol.34, no.1, pp.40-45, 2017 (Journal Indexed in SCI Expanded) identifier identifier

  • Publication Type: Article / Review
  • Volume: 34 Issue: 1
  • Publication Date: 2017
  • Doi Number: 10.4274/tjh.2015.0332
  • Title of Journal : Turkish Journal of Hematology
  • Page Numbers: pp.40-45
  • Keywords: Acute lymphoblastic leukemia, Children, Endocrine, Late effects

Abstract

© 2017 by Turkish Society of Hematology.Objective: Improvement in long-term survival in patients with acute lymphoblastic leukemia (ALL) in childhood has led to the need for monitorization of treatment-related morbidity and mortality. In the current study, we aimed to evaluate endocrine side effects of treatment in ALL survivors who were in remission for at least 2 years. Materials and Methods: Sixty patients diagnosed with ALL, who were in remission for at least 2 years, were cross-sectionally evaluated for long-term endocrine complications. Results: The median age of the patients at the time of diagnosis, at the time of chemotherapy completion, and at the time of the study was 5 years (minimum-maximum: 1.7-13), 8 years (minimum-maximum: 4.25-16), and 11.7 years (minimum-maximum: 7-22), respectively, and median follow-up time was 4 years (minimum-maximum: 2-10.1). At least one complication was observed in 81.6% of patients. Vitamin D insufficiency/deficiency (46.6%), overweight/ obesity (33.3%), and dyslipidemia (23.3%) were the three most frequent endocrine complications. Other complications seen in our patients were hyperparathyroidism secondary to vitamin D deficiency (15%), insulin resistance (11.7%), hypertension (8.3%), short stature (6.7%), thyroid function abnormality (5%), precocious puberty (3.3%), and decreased bone mineral density (1.7%). There were no statistically significant correlations between endocrine complications and age, sex, and radiotherapy, except vitamin D insufficiency/deficiency, which was significantly more frequent in pubertal ALL survivors compared to prepubertal ALL survivors (57.5% and 25%, respectively, p=0.011). Conclusion: A high frequency of endocrine complications was observed in the current study. The high frequency of late effects necessitates long-term surveillance of this population to better understand the incidence of late-occurring events and the defining of high-risk features that can facilitate developing intervention strategies for early detection and prevention.