Cardiovascular risk, cardiac function, physical activity, and quality of life with and without long-term growth hormone therapy in adult survivors of childhood acute lymphoblastic leukemia.

CONTEXT: Long-term data are missing in GH-treated acute lymphoblastic leukemia (ALL) patients. GH therapy may result in poorer outcome regarding cardiovascular (CV) and particularly cardiac effects than in patients with hypothalamic-pituitary disease.

OBJECTIVE: Our objective was to evaluate GH therapy on CV risk, cardiac function, physical activity, and quality of life in ALL patients treated with cranial radiotherapy (18-24 Gy) and chemotherapy (anthracycline dose 120 mg/m2).

DESIGN AND SETTING: We conducted a 5- and 8-yr open nonrandomized prospective study in a university hospital clinic.

STUDY PARTICIPANTS: Two groups of GH-deficient ALL patients (aged 25 yr; range 19-32 yr) and matched population controls participated.

INTERVENTIONS: One ALL group (n=16) received GH for 5 yr, and the other ALL group (n=13) did not receive GH therapy.

MAIN OUTCOME MEASURES: We evaluated the prevalence of CV risk factors and metabolic syndrome (International Diabetes Federation consensus), cardiac function (echocardiography), and quality of life and physical activity questionnaires.

RESULTS: In comparison with 8 yr without, 5 yr with GH therapy resulted in significant positive changes in plasma glucose (-0.5 vs. 0.6 mmol/liter, P=0.002), apolipoprotein B/apolipoprotein A1 ratio (-0.1 vs. 0.0, P=0.03), and high-density lipoprotein-cholesterol (0.20 vs.-0.01 mmol/liter, P=0.008) and a significant reduction in the prevalence of metabolic syndrome (P=0.008). No significant difference in the left-ventricular systolic function or in physical activity and quality of life was recorded before and after 5 or 8 yr, respectively (all P>0.3).

CONCLUSION: GH therapy reduced the CV risk in this young ALL population but resulted in no clear benefit or deterioration in cardiac function.