Frequency of Metabolic Syndrome and the Role of Radiotherapy in Patients with Acute Lymphoblastic Leukemia Who Completed Therapy.
Authors: Oymak Yesim , Turedi Aysen , Yaman Yontem , Buyukinan Muammer , Kavakli Kaan , Vergin Canan 
Published: October 2019

Abstract
Abstract 4551

Objective
The aim of the study was to evaluate the frequency of metabolic syndrome and its components, and the effect of radiotherapy on the development of metabolic syndrome and its components in patients with acute lymphoblastic leukemia (ALL) who completed therapy.

Material method
Age of diagnosis, time elapsed since discontinuation of treatment, gender and risk group information were recorded for 40 ALL patients with completed therapy who were enrolled in the study. Height, body weight, systolic and diastolic blood pressure levels, HDL, LDL, triglyceride, total cholesterol, fasting blood sugar (FBS) and insulin levels were determined. The patients' height SDS, body mass index (BMI) and BMI percentiles were calculated.
Considering age and gender, patients in the BMI percentile of 85-95 were considered overweight, and patients above the 95 percentile were considered obese. Height SDS < -2 SDS was considered as shortness in height. 90 and 95 p systolic and diastolic blood pressure values by height percentile were taken as basis for the blood pressure assessment. WHO (modified) criteria were used for diagnosing the metabolic syndrome. HOMA-IR > 4 was accepted as insulin resistance for evaluating insulin resistance.

Results
A total of 40 patients, 24 females and 16 males, were enrolled in the study. Median age was 49 months (16-165), and the median time lapsed since discontinuation of treatment was 12 (1-96) months.
19 of the patients were in the standard risk group (SRG), 18 were in the moderate risk group (MRG), and 3 were in the high risk group (HRG) and 20 patients had received radiotherapy.
Seven patients were obese, six patients were overweight, eight patients had insulin resistance, one patient had impaired fasting glucose tolerance, six cases were diagnosed with hypertension, seven with dyslipidemia, and five cases with metabolic syndrome.
While no difference was observed in groups that received and did not receive radiotherapy in terms of BMI, HOMA IR, insulin, FBS, triglyceride, LDL, and T cholesterol (p>0.05), the HDL value was observed to be higher in the group which did not receive radiotherapy (p=0.032). No difference could be observed between the two groups in terms of obesity, overweight, impaired fasting glucose tolerance, hypertension, dyslipidemia, and metabolic syndrome parameters. The difference between the radiotherapy and non-radiotherapy groups' mean SDS values (-0.48/-0.23) was not significant.
While no difference could be observed in the BMI, HOMA IR, insulin, FBS, triglyceride, LDL, total cholesterol levels of the ALL risk groups (p>0.05), a difference in the HDL value was found among the groups (p<0.05). A difference in obesity, overweight, impaired fasting glucose tolerance, hypertension, dislipidemia, metabolic syndrome among the groups, and a difference in mean height SDS of the groups (-0.23/-0.55/-0.15) could not be found (p>0.05). Three patients had height measurements below -2SDS. A difference could not be observed among the risk groups and between RT and non-RT groups in terms of shortness in height.

Discussion
A difference could not be observed between the radiotherapy and non-radiotherapy groups in terms of metabolic syndrome. However, the importance of monitoring weight, height, and metabolic parameters during routine controls of children with ALL who completed therapy is once more underlined as metabolic syndrome was seen in 12.5% percent of the study subjects.

Disclosures:
No relevant conflicts of interest to declare.