Principal Investigator: K. Scott Baker, M.D.

Adult survivors of acute leukemia in childhood have a higher than expected frequency of obesity and early mortality from cardiovascular disease. Although limited, there is evidence to indicate that survivors of childhood cancer are also at increased risk for the metabolic syndrome, a constellation of disorders characterized by central obesity, insulin resistance, glucose intolerance, dyslipidemia, and hypertension, and that this risk may be even higher in children who have received hematopoietic cell transplant (HCT) as part of their therapy. We propose to conduct a clinical study to evaluate the relation between insulin resistance, growth hormone deficiency and other mediators of insulin resistance, with the development of metabolic syndrome in a sample of adolescent and young adult survivors of childhood leukemia who underwent HCT; to compare the prevalence of metabolic syndrome in HCT survivors to the general population; and to compare specific measures of insulin resistance and metabolic syndrome to age/sex matched control subjects that have been studied in a similar fashion. We will also investigate whether endothelial impairment and other early signs of cardiovascular disease are significantly more prevalent among the HCT survivors with metabolic syndrome, compared to those without metabolic syndrome. This study will provide compelling data that is not present in the current literature on the risk of the metabolic syndrome in HCT survivors and regarding the magnitude of the clinical features. Moreover, studying the components of the metabolic syndrome early in life will provide insight into their sequence of development before they become complex and disease develops. This information may also provide us with the opportunity to design future studies aimed towards prevention and/or intervention for at risk individuals.