ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Cancer. 2018 Sep 1; 124 (17): 3576.

Glucocorticoids still represent one of the pillars in the treatment of paediatric hematologic malignancies, but they cause excessive weight gain through several mechanisms. However, it is unclear whether these glucocorticoids have a long-lasting effect on body weight, because studies have focused mainly on the acute effects during or shortly after treatment (1–2).

This large Swiss study examined the relationship betwen cumulative glucocorticoid dose and overweight in childhood cancer survivors (CCS) long after the completion of treatment (median time from diagnosis 17 years). CCS treated with glucocorticoids only had the same prevalence of overweight and obesity compared to that of siblings and the general population (24%), but higher prevalences were evident in patients who had undergone cranial radiotherapy (37%) or cranial radiotherapy plus glucocorticoid treatment (49%). No correlation was found between cumulative corticosteroid dose and overweight. The strengths of the study are the large sample size (1936 CCS, comparison groups: 546 siblings, 9591 subjects from a random sample of the general Swiss population) and the separate analysis of patients with the three types of cancer most often treated with glucocorticoids (acute lymphoblastic leukaemia, non-Hodgkin and Hodgkin lymphoma).

These results reassuringly show that glucocorticoids used for the treatment of childhood cancer are not associated with long-term risk of overweight. However, the study has some limitations. They relied on self-reported height and weight, and BMI was the only parameter used to evaluate overweight. It is well known that BMI fails to measure the complex changes of body composition induced by cancer treatment, with lean mass impairment, fat tissue redistribution and increased abdominal adiposity. Another limitation is that glucocorticoid cumulative dose was estimated only indirectly by the type of protocol used.

References: 1. Chow EJ, Pihoker C, Hunt K, Wilkinson K, Friedman DL. Obesity and hypertension among children after treatment for acute lymphoblastic leukemia. Cancer. 2007; 110: 2313–2320.

2. Arpe ML, Rørvig S, Kok K, Mølgaard C, Frandsen TL. The association between glucocorticoid therapy and BMI z-score changes in children with acute lymphoblastic leukemia. Support Care Cancer. 2015; 23: 3573–3580.