Late endocrine complications in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy-only protocol: a cross-sectional study

Abstract

Background. Modern treatment protocols for childhood acute lymphoblastic leukemia (ALL) have greatly improved survival; however, a growing number of survivors experience late endocrine complications as a consequence of treatment. The purpose was to evaluate the spectrum and frequency of late endocrine complications in childhood ALL survivors managed with a chemotherapy-only regimen. Materials and methods. A non-randomized, analytic cross-sectional study was conducted on 50 patients diagnosed with ALL between March 2011 and February 2020 at the Pediatric Hemato-Oncology Center, Children’s Central Teaching Hospital, in Baghdad, Iraq. All participants had achieved complete remission for at least 2 years. Clinical and laboratory investigations were performed to identify late endocrine complications. Results. Overweight and obesity were identified in 16 patients (32 %) and were significantly associated with age younger than 5 years at diagnosis (p = 0.044). Short stature was observed in 3 patients (6 %). Prediabetes was detected in 6 patients (12 %) and showed a significant association with overweight and obesity (p = 0.009). Subclinical hypothyroidism and delayed puberty were each detected in one patient (2 %). No significant associations were found between short stature, prediabetes, thyroid dysfunction, or delayed puberty with respect to age or sex. Conclusions. Overweight and obesity were the most frequent endocrine late complications among childhood ALL survivors and were associated with younger age at diagnosis. Prediabetes was more common in overweight and obese patients, highlighting the importance of long-term metabolic surveillance in this population.