Evaluation of Endocrine Late Complications in Childhood Acute Lymphoblastic Leukemia Survivors: A Report of a Single-Center Experience and Review of the Literature

摘要

Objective: Improvement in long-term survival in patients with acutelymphoblastic leukemia (ALL) in childhood has led to the need formonitorization of treatment-related morbidity and mortality. Inthe current study, we aimed to evaluate endocrine side effects oftreatment in ALL survivors who were in remission for at least 2 years.Materials and Methods: Sixty patients diagnosed with ALL, whowere in remission for at least 2 years, were cross-sectionally evaluatedfor 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 thestudy was 5 years (minimum-maximum: 1.7-13), 8 years (minimummaximum:4.25-16), and 11.7 years (minimum-maximum: 7-22),respectively, and median follow-up time was 4 years (minimummaximum: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 mostfrequent endocrine complications. Other complications seen in ourpatients 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 statisticallysignificant correlations between endocrine complications and age, sex,and radiotherapy, except vitamin D insufficiency/deficiency, whichwas significantly more frequent in pubertal ALL survivors comparedto prepubertal ALL survivors (57.5% and 25%, respectively, p=0.011).Conclusion: A high frequency of endocrine complications wasobserved in the current study. The high frequency of late effectsnecessitates long-term surveillance of this population to betterunderstand the incidence of late-occurring events and the definingof high-risk features that can facilitate developing interventionstrategies for early detection and prevention.