Late complications of childhood acute lymphoblastic leukaemia (ALL), with special reference to hormone secretion, cardiovascular risk and bone health

Abstract: An increased prevalence of cardiovascular (CV) risk factors and cardiac abnormalities has been shown among adult GH deficient ALL survivors subjected to cranial irradiation. The ALL treatment includes many known risk factors for low bone mineral density (BMD), but little is known about pituitary insufficiencies, except for GH deficiency. In study I we evaluated the impact of 2 years GH therapy on CV risk and cardiac function and in study II, 5 years of GH therapy and 8 years without. In study III, BMD was evaluated 20 years after diagnosis, and also after another 5 years with GH therapy and 8 years without. In study IV we evaluated the prevalence of PRL and thyroid hormone insufficiency and the effect of GH therapy on these levels. We have shown that GH therapy in ALL survivors, both of short - and long term duration decreases the prevalence of metabolic syndrome and of CV risk factors. An improvement in cardiac systolic function was recorded after 2 years of GH therapy, but after 5 years, this improvement was not sustained. Twenty years after diagnosis, BMD was normal among ALL patients compared to matched controls, but during follow up BMD Z-score had decreased, irrespective of a low dose of GH therapy. ALL survivors were PRL insufficient 20 years after diagnosis, with a further decline in PRL levels after another 5 and 8 years, irrespective of GH therapy, indicating a progressive radiation effect. In contrast, normal thyroid hormone function was recorded.