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 haematopoietic 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 as follows: leukaemia, HSCT+TBI, aged ≤ 24 years at HSCT and 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 are 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 utilizing nutritional manipulation and/or targeted activity, should be investigated.

中文翻译：

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儿童和青少年同种异体造血细胞移植/全身照射后的身体成分：有限的系统评价。

 目的

旨在整理儿童、青少年和年轻人（CTYA，0-24 岁）采用同种异体造血干细胞移植和全身照射（HSCT+TBI）治疗白血病后身体成分变化的证据。

 方法

论文是通过搜索 Medline 和 Google Scholar、参考文献列表/引文以及联系主要作者来确定的，没有日期或语言限制。纳入标准如下：白血病、HSCT+TBI、HSCT时年龄≤24岁以及身体成分变化（总脂肪、中心性肥胖、脂肪组织功能、肌肉质量、肌肉功能）。使用简短的纽卡斯尔-渥太华量表评估质量。

 结果

在 900 篇论文中，纳入了 20 篇：7 篇对照研究、5 篇非对照研究和 8 篇病例报告。学习质量看起来不错。几乎没有证据表明 HSCT + TBI 组的总脂肪/体重存在差异（与健康对照/人群正常/身材矮小对照相比）。有一些证据表明，中心性肥胖明显较高，并且脂肪组织功能存在差异（与白血病/非白血病对照相比）。肌肉质量明显较低（与健康/肥胖对照相比）。肌肉功能结果尚无定论，但表明存在损伤。病例报告证实了脂肪营养不良表型。

 结论

CTYA 白血病在 HSCT + TBI 后，脂肪组织的早期重塑和骨骼肌丧失很明显，具有明显的脂肪营养不良的极端表型。有一些证据表明肌肉效率降低。

对癌症幸存者的影响

HSCT + TBI 后患者的身体成分变化在成年早期就很明显，并且与成年幸存者出现过度心脏代谢发病率的风险相关。应研究改善肌肉和/或脂肪功能的干预措施，也许利用营养控制和/或有针对性的活动。