Body composition after allogeneic hematopoietic cell transplantation / total body irradiation in children and young people: a restricted systematic review

Ava Lorenc, Julian P H Shield, Rachel E Perry, Michael Stevens*, CTYA HSCT Adipose and Muscle late effects working group

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

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Abstract

Purpose
To collate evidence of changes in body composition following treatment of leukaemia in children, teenagers and young adults (CTYA, 0-24 years) with allogeneic hematopoietic stem cell transplant and total body irradiation (HSCT+TBI).

Methods
Papers were identified by searching Medline and Google Scholar, reference lists/citations and contacting key authors, with no date or language restrictions. Inclusion criteria were: leukaemia, HSCT+TBI, aged ≤24 years at HSCT, changes in body composition (total fat, central adiposity, adipose tissue function, muscle mass, muscle function). Quality was assessed using a brief Newcastle-Ottawa scale.

Results
Of 900 papers, 20 were included: seven controlled, five uncontrolled studies and eight case reports. Study quality appeared good. There was little evidence of differences in total fat/weight for HSCT+TBI groups (compared to healthy controls/population norms/short stature controls). There was some evidence of significantly higher central adiposity and differences in adipose tissue function (compared to leukaemic/non-leukaemic controls). Muscle mass was significantly lower (compared to healthy/obese controls). Muscle function results were inconclusive but suggested impairment. Case reports confirmed a lipodystrophic phenotype.

Conclusions
Early remodelling of adipose tissue and loss of skeletal muscle is evident following HSCT+TBI for CTYA leukaemia, with extreme phenotype of overt lipodystrophy. There is some evidence for reduced muscle effectiveness.

Implications for Cancer Survivors
Body composition changes in patients after HSCT+TBI are apparent by early adult life and link with the risk of excess cardiometabolic morbidity seen in adult survivors. Interventions to improve muscle and/or adipose function, perhaps utilising nutritional manipulation and/or targeted activity, should be investigated.
Original languageEnglish
Number of pages19
JournalJournal of Cancer Survivorship
Early online date18 Jul 2020
DOIs
Publication statusE-pub ahead of print - 18 Jul 2020

Keywords

  • Stem Cell Transplantation
  • leukemia
  • lipodystrophy
  • sarcopenia
  • adipose tissue

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