Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia

Emily S. Tonorezos, Peter G. Snell, Chaya S. Moskowitz, Debra A. Eshelman-Kent, Jennifer E. Liu, Joanne F. Chou, Stephanie M. Smith, Andrea L. Dunn, Timothy S. Church, Kevin C. Oeffinger

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited. Procedure: To assess cardiorespiratory fitness, maximal oxygen uptake (VO2max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest. Results: Compared to NHANES participants, ALL survivors had a substantially lower VO2max (mean 30.7 vs. 39.9ml/kg/min; adjusted P<0.0001). For any given percent total body fat, ALL survivors had an 8.9ml/kg/min lower VO2max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2max compared with NHANES participants (all comparisons, P<0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P<0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2max. Among females, CRT was associated with low VO2max (P=0.02), but anthracycline exposure was not (P=0.58). In contrast, among males, anthracycline exposure ≥100mg/m2 was associated with low VO2max (P=0.03), but CRT was not (P=0.54). Conclusion: Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.

Original languageEnglish (US)
Pages (from-to)1358-1364
Number of pages7
JournalPediatric Blood and Cancer
Volume60
Issue number8
DOIs
StatePublished - Aug 2013

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Survivors
Nutrition Surveys
Anthracyclines
Health
Radiotherapy
Linear Models
Cardiorespiratory Fitness
Therapeutics
Population
Adipose Tissue
Oxygen
Drug Therapy

Keywords

  • Acute lymphoblastic leukemia
  • Cardiorespiratory fitness
  • Childhood cancer
  • Survivor

ASJC Scopus subject areas

  • Oncology
  • Pediatrics, Perinatology, and Child Health
  • Hematology

Cite this

Tonorezos, E. S., Snell, P. G., Moskowitz, C. S., Eshelman-Kent, D. A., Liu, J. E., Chou, J. F., ... Oeffinger, K. C. (2013). Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia. Pediatric Blood and Cancer, 60(8), 1358-1364. https://doi.org/10.1002/pbc.24492

Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia. / Tonorezos, Emily S.; Snell, Peter G.; Moskowitz, Chaya S.; Eshelman-Kent, Debra A.; Liu, Jennifer E.; Chou, Joanne F.; Smith, Stephanie M.; Dunn, Andrea L.; Church, Timothy S.; Oeffinger, Kevin C.

In: Pediatric Blood and Cancer, Vol. 60, No. 8, 08.2013, p. 1358-1364.

Research output: Contribution to journalArticle

Tonorezos, ES, Snell, PG, Moskowitz, CS, Eshelman-Kent, DA, Liu, JE, Chou, JF, Smith, SM, Dunn, AL, Church, TS & Oeffinger, KC 2013, 'Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia', Pediatric Blood and Cancer, vol. 60, no. 8, pp. 1358-1364. https://doi.org/10.1002/pbc.24492
Tonorezos ES, Snell PG, Moskowitz CS, Eshelman-Kent DA, Liu JE, Chou JF et al. Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia. Pediatric Blood and Cancer. 2013 Aug;60(8):1358-1364. https://doi.org/10.1002/pbc.24492
Tonorezos, Emily S. ; Snell, Peter G. ; Moskowitz, Chaya S. ; Eshelman-Kent, Debra A. ; Liu, Jennifer E. ; Chou, Joanne F. ; Smith, Stephanie M. ; Dunn, Andrea L. ; Church, Timothy S. ; Oeffinger, Kevin C. / Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia. In: Pediatric Blood and Cancer. 2013 ; Vol. 60, No. 8. pp. 1358-1364.
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abstract = "Background: Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited. Procedure: To assess cardiorespiratory fitness, maximal oxygen uptake (VO2max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest. Results: Compared to NHANES participants, ALL survivors had a substantially lower VO2max (mean 30.7 vs. 39.9ml/kg/min; adjusted P<0.0001). For any given percent total body fat, ALL survivors had an 8.9ml/kg/min lower VO2max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2max compared with NHANES participants (all comparisons, P<0.001). Almost two-thirds (66.7{\%}) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3{\%} of NHANES participants (adjusted P<0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2max. Among females, CRT was associated with low VO2max (P=0.02), but anthracycline exposure was not (P=0.58). In contrast, among males, anthracycline exposure ≥100mg/m2 was associated with low VO2max (P=0.03), but CRT was not (P=0.54). Conclusion: Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.",
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T1 - Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia

AU - Tonorezos, Emily S.

AU - Snell, Peter G.

AU - Moskowitz, Chaya S.

AU - Eshelman-Kent, Debra A.

AU - Liu, Jennifer E.

AU - Chou, Joanne F.

AU - Smith, Stephanie M.

AU - Dunn, Andrea L.

AU - Church, Timothy S.

AU - Oeffinger, Kevin C.

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N2 - Background: Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited. Procedure: To assess cardiorespiratory fitness, maximal oxygen uptake (VO2max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest. Results: Compared to NHANES participants, ALL survivors had a substantially lower VO2max (mean 30.7 vs. 39.9ml/kg/min; adjusted P<0.0001). For any given percent total body fat, ALL survivors had an 8.9ml/kg/min lower VO2max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2max compared with NHANES participants (all comparisons, P<0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P<0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2max. Among females, CRT was associated with low VO2max (P=0.02), but anthracycline exposure was not (P=0.58). In contrast, among males, anthracycline exposure ≥100mg/m2 was associated with low VO2max (P=0.03), but CRT was not (P=0.54). Conclusion: Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.

AB - Background: Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited. Procedure: To assess cardiorespiratory fitness, maximal oxygen uptake (VO2max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest. Results: Compared to NHANES participants, ALL survivors had a substantially lower VO2max (mean 30.7 vs. 39.9ml/kg/min; adjusted P<0.0001). For any given percent total body fat, ALL survivors had an 8.9ml/kg/min lower VO2max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2max compared with NHANES participants (all comparisons, P<0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P<0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2max. Among females, CRT was associated with low VO2max (P=0.02), but anthracycline exposure was not (P=0.58). In contrast, among males, anthracycline exposure ≥100mg/m2 was associated with low VO2max (P=0.03), but CRT was not (P=0.54). Conclusion: Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.

KW - Acute lymphoblastic leukemia

KW - Cardiorespiratory fitness

KW - Childhood cancer

KW - Survivor

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