Adverse metabolic and cardiovascular risk following treatment of acute lymphoblastic leukaemia in childhood; two case reports and a literature review

We report two patients who survived childhood acute lymphoblastic leukaemia (ALL) following treatment with chemotherapy, total body irradiation (TBI) and bone marrow transplantation (BMT). The first case presented with an acu te cerebral infarction at 23 years of age and was found to have non-ketotic diabetes and gross mixed hyperlipidaemia; the second presented with non-ke totic diabetes, hypertension, proteinuria and dyslipidaemia at age 16 years . The association of glucose intolerance with other vascular risk factors i n young adult survivors of BMT was recently highlighted in a follow-up stud y of 23 survivors of BMT [1], but none presented with such gross mixed hype rlipidaemia. The improving survival rates of childhood malignancy over the last two decades will present adult physicians with patients who have accel erated vascular risk at a young age who will require early treatment to mod ify it.