Impaired glucose tolerance and dyslipidaemia as late effects after bone-marrow transplantation in childhood

Background This follow-up study aimed to assess the frequency of late effec ts on glucose and lipid metabolism after bone-marrow transplantation in chi ldhood. Methods 23 long-term survivors (median age 20 years) were studied 3-18 year s after bone-marrow transplantation and compared with 23 healthy controls m atched for age and sex and with 13 patients in remission from leukaemia. Findings 12 (52%) of the 23 bone-marrow transplantation patients had insuli n resistance, including impaired glucose tolerance in six and type 2 diabet es in four. The core signs of the metabolic syndrome (hyperinsulinaemia and hypertriglyceridaemia combined), were found in nine (39%) of the bone-marr ow transplantation patients compared with one (8%) of the 13 leukaemia pati ents and none of the healthy controls (p=0.0015). The frequency of insulin resistance increased with the time since bone-marrow transplantation. Abdom inal obesity, but not overweight, was common among the patients with insuli n resistance. Interpretation Long-term survivors of bone-marrow transplantation are at su bstantial risk of insulin resistance, impaired glucose tolerance, and type 2 diabetes even at normal weight and young age. They also develop typical s igns of the metabolic syndrome. We advocate measurement of serum lipids, fa sting blood glucose, and serum insulin for the follow-up of all patients wh o undergo transplants in childhood, to be continued regularly and possibly lifelong.