DOI QR코드

DOI QR Code

Impact of Chemotherapy-Related Hyperglycemia on Prognosis of Child Acute Lymphocytic Leukemia

  • Zhang, Bi-Hong (Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University) ;
  • Wang, Jian (Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University) ;
  • Xue, Hong-Man (Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University) ;
  • Chen, Chun (Department of Pediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University)
  • Published : 2014.11.06

Abstract

Purpose: To investigate the impact of hyperglycemia during inductive treatment on the prognosis of acute lymphocytic leukemia (ALL) in children. Materials and Methods: Clinical data of 159 ALL childhood cases were reviewed. The patients were divided into the hyperglycemia group (fasting $glucose{\geq}126mg/dl$ and/or random blood $glucose{\geq}200mg/dl$) and the euglycemia group according to the blood glucose values. The X2 test was performed to compare the complete remission rates of the two groups, and Kaplan-Meier and log-rank tests were performed to compare the 5-year overall and relapse-free survival. Results: The incidence of hyperglycemia in the $age{\geq}10-year-old$ group was higher than the younger-age group (P=0.009). Values in the interim- and high-risk groups were higher than the standard-risk group (P=0.028), while there was no significant difference between genders (P=0.056). The complete remission rates of the 2 groups demonstrated no significant difference (P=0.134), while the 5-year OS of the hyperglycemia group was lower than in the euglycemia group ($83.8{\pm}6.0%$ vs $94.9{\pm}2.4%$, P=0.014). The 5 -year RFS was significantly lower than the euglycemia group ($62.9{\pm}8.7%$) vs $80.2{\pm}9.1%$, P<0.001). Conclusions: Children with $age{\geq}10year$ old, and in the middle- and high-risk groups appear prone to complicating hyperglycemia during inductive chemotherapy, associated with lower 5-year OS and RFS.

Keywords

References

  1. Ali NA, O'Brien JM, Blum W, et al (2007). Hyperglycemia in patients with acute myeloid leukemia is associated with increased hospital mortality. Cancer, 110, 96-102. https://doi.org/10.1002/cncr.22777
  2. Belgaumi AF, Al-Bakrah M, Al-Mahr M, et al (2003). Dexamethasone-associated toxicity during induction chemotherapy for childhood acute lymphoblastic leukemia is augmented by concurrent use of daunomycin. Cancer, 97, 2898-903. https://doi.org/10.1002/cncr.11390
  3. Bochicchio GV, Bochicchio KM, Joshi M, et al (2010). Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients. Ann Surg, 252, 597-602.
  4. Brown VI, Seif AE, Reid GS, et al (2008). Novel molecular and cellular therapeutic targets in acute lymphoblastic leukemia and lymphoproliferative disease. Immunol Res, 42, 84-105. https://doi.org/10.1007/s12026-008-8038-9
  5. Devos P, Preiser JC (2004). Tight blood glucose control: a recommendation ap-plicable to any critically ill patient? Crit Care, 8, 427-9. https://doi.org/10.1186/cc2989
  6. Faustino EV, Apkon M (2005). Persistent hyperglycemia in critically ill chil dren. J Pediatr, 146, 30-4. https://doi.org/10.1016/j.jpeds.2004.08.076
  7. Feng YH, Velazquez-Torres G, Gully C, et al (2011). The impact of type 2 diabetes and antidiabetic drugs on cancer cell growth. J Cell Mol Med, 15, 825-36. https://doi.org/10.1111/j.1582-4934.2010.01083.x
  8. Hunger SP, Lu X, Devidas M, et a1 (2012). Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005: a report from the children's oncology group. J Clin Oncol, 30, 1663-9. https://doi.org/10.1200/JCO.2011.37.8018
  9. Lowas SR, Marks D and Malempati S (2009). Prevalence of transient hyperglycemia during induction chemotherapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer, 52, 814-8. https://doi.org/10.1002/pbc.21980
  10. Pan JX, Chen C, Jin, Y, et al (2012). Differential impact of structurally different anti-diabetic drugs on proliferation and chemosensitivity of acute lymphoblastic leukemia cells. Cell Cycle, 11, 2314-26. https://doi.org/10.4161/cc.20770
  11. Roberson JR, Raju S, Shelso J, et al (2008). Diabetic ketoacidosis during therapy for pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer, 50, 1207-12. https://doi.org/10.1002/pbc.21505
  12. Roberson JR, Spraker HL, Shelso J, et al (2009). Clinical consequences of hyperglycemia during remission induction therapy for pediatric acute lymphoblastic leukemia. Leukemia, 23, 245-50. https://doi.org/10.1038/leu.2008.289
  13. Seshasai SR, Kaptoge S, Thompson A, et al (2011). Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose and risk of cause-specific death. N Engl J Med, 364, 829-41. https://doi.org/10.1056/NEJMoa1008862
  14. Sonabend RY, McKay SV, Okcu M, et al (2009). Hyperglycemia during induction therapy is associated with poorer survival in children with acute lymphocytic leukemia. J Pediatr, 155, 73-8. https://doi.org/10.1016/j.jpeds.2009.01.072
  15. Sonabend RY, McKay SV, Okcu MF, et al (2008). Hyperglycemia during induction therapy is associated with increased infectious complications in childhood acute lymphocytic leukemia. Pediatr Blood Cancer, 51, 387-92. https://doi.org/10.1002/pbc.21624
  16. Spinola-Castro AM, Siviero-Miachon AA, Andreoni S, et al (2009). Transient hyperglycemia during childhood acute lymphocytic leukemia chemotherapy: an old event revisited. Clin Adv Hematol Oncol, 7, 465-72.
  17. Vu K, Busaidy N, Cabanillas ME, et al (2012). A randomized controlled trial of an intensive insulin regimen in patients with hyperglycemic acute lymphoblastic leukemia. Clin Lymphoma Myeloma Leuk, 12, 355-62. https://doi.org/10.1016/j.clml.2012.05.004
  18. Weiser MA, Cabanillas ME, Konopleva M, et al (2004). Relation between the duration of remission and hyperglycemia during induction chemotherapy for acute lymphocytic leukemia with ahyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone/methotrexate-cytar-abine regimen. Cancer, 100, 1179-85. https://doi.org/10.1002/cncr.20071
  19. Yeung SJ, Pan J and Lee MH (2008). Roles of p53, MYC and HIF-1 in regulating glycolysis-the seventh hallmark of cancer. Cell Mol Life Sci, 65, 3981-99. https://doi.org/10.1007/s00018-008-8224-x

Cited by

  1. Evaluation of Insulin-mediated Regulation of AKT Signaling in Childhood Acute Lymphoblastic Leukemia vol.41, pp.2, 2019, https://doi.org/10.1097/MPH.0000000000001425