Evaluation of metabolic syndrome and growth disorder in long-term survivors of hematopoietic stem cell transplantation in children

Background Treatment improvement in hematopoietic stem cell transplantation (HSCT) in children has lowered HSCTassociated mortality rate, with increased long-term survivors' complications. The metabolic syndrome (MetS), as well as growth failure observed among HSCT survivors, can be related to the patient's primary illness or a complication of the HSCT. Aim To assess the frequency and possible risks of MetS and growth failure among HSCT survivors treated at our center. Patients and methods This study included 22 patients who underwent HSCT between 2011 and 2020 at the Pediatric Blood and Marrow Transplant Unit, Ain Shams University Hospital and survived for more than 1 year after HSCT with a mean age of 12.95 years, and a mean duration posttransplant of 5.95 years. Three patients were transplanted for malignant diseases, and all patients received chemotherapy only in a conditioning regimen. Detailed medical history, physical examination, and laboratory assessment, including complete blood count, fasting plasma glucose, fasting insulin, homeostatic model assessment of insulin resistance, glycated hemoglobin, fasting lipid profile, thyroid function and growth hormone stimulation tests for patients with height less than -3 SD were done. Results The frequency of MetS in our study was 4.5%, with 40.9% showing two components of MetS and 18.1% having one component of MetS. Dyslipidemia was detected in 68.2% with 50% developed hypertriglyceridemia, 45.4% had low high-density lipoprotein-cholesterol. 36.4% showed insulin resistance, 4.5% had impaired fasting glucose, yet none was diabetic. 9.1% had elevated blood pressure, and 4.5% had abdominal obesity. Multivariate analysis confirmed a significant positive association (P=0.019) between acute graft-versus-host disease and insulin resistance and a significantly elevated free T3 among patients with insulin resistance (P=0.011). Conclusion The current study proved a high prevalence of MetS components, specifically dyslipidemia (68.2%) and insulin resistance (36.4%) among HSCT survivors, mandating regular screening of MetS components in the long-term follow-up of those survivors.