Ryuichi Nakagawa1, Atsumi Hosokawa-Tsuji1, Yuki Aoki1,2, Kei Takasawa1, Mitsue Maru3,4, Keisuke Nakajima1, Akito Sutani1, Yuichi Miyakawa1, Daisuke Tomizawa1,5, Kenichi Kashimada6, Tomohiro Morio1. 1. Division of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-Ward, Tokyo, 113-8510, Japan. 2. Department of Pediatric Oncology, National Cancer Center Hospital, Chuou-Ward, Tokyo, 104-0045, Japan. 3. School of Healthcare Science, Faculty of Medicine, Tokyo Medical and Dental University, Bunkyo-Ward, Tokyo, 113-8510, Japan. 4. International Nursing Development, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe City, Hyogo Prefecture, 658-0001, Japan. 5. Children's Cancer Center, National Center for Child Health and Development, Setagaya-Ward, Tokyo, 157-8535, Japan. 6. Division of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Bunkyo-Ward, Tokyo, 113-8510, Japan. kkashimada.ped@tmd.ac.jp.
Abstract
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a curative treatment for life-threatening malignancies and related diseases. Recently, the long-term prognosis of HSCT during childhood has greatly improved; however, the late adverse effects of HSCT have been found to cause substantial morbidity among long-term survivors. Although metabolic complications, such as diabetes mellitus (DM) and hyperlipidemia (HL), are the major late effects of pediatric HSCT, the clinical details are not clarified sufficiently. METHODS: From 1983 to 2013, 75 participants underwent HSCT in our institute because of malignant or other related diseases. We retrospectively evaluated metabolic complications of eligible 22 participants (14 men and 8 women), and their clinical backgrounds. RESULTS: Among 22 participants, 4 and 9 participants developed DM and HL after HSCT, respectively, and all participants with DM developed HL. None of the participants with DM were obese, and all had substantial insulin resistance. Total body irradiation (TBI) was performed in 10 participants, including 4 participants with DM and 5 participants with HL, revealing that TBI is an independent risk factor for DM. The age at TBI for participants with DM was significantly lower than that for participants without DM (p = 0.01), and all participants with DM received TBI before the age of 6. CONCLUSIONS: Our data suggested that TBI was a risk factor for DM after HSCT, and TBI before the age of six increased the possibility of DM without obesity.
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a curative treatment for life-threatening malignancies and related diseases. Recently, the long-term prognosis of HSCT during childhood has greatly improved; however, the late adverse effects of HSCT have been found to cause substantial morbidity among long-term survivors. Although metabolic complications, such as diabetes mellitus (DM) and hyperlipidemia (HL), are the major late effects of pediatric HSCT, the clinical details are not clarified sufficiently. METHODS: From 1983 to 2013, 75 participants underwent HSCT in our institute because of malignant or other related diseases. We retrospectively evaluated metabolic complications of eligible 22 participants (14 men and 8 women), and their clinical backgrounds. RESULTS: Among 22 participants, 4 and 9 participants developed DM and HL after HSCT, respectively, and all participants with DM developed HL. None of the participants with DM were obese, and all had substantial insulin resistance. Total body irradiation (TBI) was performed in 10 participants, including 4 participants with DM and 5 participants with HL, revealing that TBI is an independent risk factor for DM. The age at TBI for participants with DM was significantly lower than that for participants without DM (p = 0.01), and all participants with DM received TBI before the age of 6. CONCLUSIONS: Our data suggested that TBI was a risk factor for DM after HSCT, and TBI before the age of six increased the possibility of DM without obesity.
Entities:
Keywords:
Diabetes mellitus; Hematopoietic stem cell transplantation; Hyperlipidemia; Survivors; Total body irradiation
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