Body composition after allogeneic haematopoietic cell transplantation/total body irradiation in children and young peopl
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REVIEW
Body composition after allogeneic haematopoietic cell transplantation/total body irradiation in children and young people: a restricted systematic review Ava Lorenc 1 & Julian Hamilton-Shield 1 & Rachel Perry 1 & Michael Stevens 1 & on behalf of the CTYA HSCT Adipose and Muscle Late Effects Working Group
Received: 25 November 2019 / Accepted: 29 February 2020 # The Author(s) 2020
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 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. Keywords Stem cell transplantation . Leukaemia . Lipodystrophy . Sarcopenia . Adipose tissue
Introduction Leukaemia is the commonest type of cancer in children (0 to < 16 years) and one of the most common diagnoses affecting Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11764-020-00871-1) contains supplementary material, which is available to authorized users. * Michael Stevens [email protected] 1
NIHR Bristol Biomedical Research Centre (Nutrition Theme), Level 3, University Hospitals Bristol Education and Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK
teenagers and young adults (16 to < 25 years). Patients who fail primary treatment, or those with very high risk factors at diagnosis, may be
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