Body composition after allogeneic haematopoietic cell transplantation/total body irradiation in children and young people: a restricted systematic review

• Published in: Journal of cancer survivorship 2020-10, Vol.14 (5), p.624-642
• Main Authors: Lorenc, Ava, Hamilton-Shield, Julian, Perry, Rachel, Stevens, Michael
• Format: Article
• Language: English
• Subjects: Adipose tissue; Adolescent; Adolescents; Adult; Body Composition; Cancer Survivors - statistics & numerical data; Case reports; Child; Children; Health Informatics; Health Promotion and Disease Prevention; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; Irradiation; Leukemia; Leukemia - pathology; Leukemia - therapy; Lipodystrophy; Medicine; Medicine & Public Health; Morbidity; Muscle function; Muscles; Norms; Nutritional status; Obesity - etiology; Obesity - pathology; Oncology; Phenotypes; Primary Care Medicine; Public Health; Quality assessment; Quality of Life Research; Radiation; Review; Sarcopenia; Search engines; Skeletal muscle; Stem cell transplantation; Stem cells; Systematic review; Transplantation; Transplants & implants; Whole-Body Irradiation - adverse effects; Young Adult; Young adults
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-020-00871-1

Purpose To collate evidence of changes in body composition following treatment of leukaemia in children, teenagers and young adults (CTYA, 0–24 years) with allogeneic haematopoietic stem cell transplant and total body irradiation (HSCT+TBI). Methods Papers were identified by searching Medline and Google Scholar, reference lists/citations and contacting key authors, with no date or language restrictions. Inclusion criteria were as follows: leukaemia, HSCT+TBI, aged ≤ 24 years at HSCT and changes in body composition (total fat, central adiposity, adipose tissue function, muscle mass, muscle function). Quality was assessed using a brief Newcastle–Ottawa scale. Results Of 900 papers, 20 were included: seven controlled, five uncontrolled studies and eight case reports. Study quality appeared good. There was little evidence of differences in total fat/weight for HSCT + TBI groups (compared to healthy controls/population norms/short stature controls). There was some evidence of significantly higher central adiposity and differences in adipose tissue function (compared to leukaemic/non-leukaemic controls). Muscle mass was significantly lower (compared to healthy/obese controls). Muscle function results were inconclusive but suggested impairment. Case reports confirmed a lipodystrophic phenotype. Conclusions Early remodelling of adipose tissue and loss of skeletal muscle are evident following HSCT + TBI for CTYA leukaemia, with extreme phenotype of overt lipodystrophy. There is some evidence for reduced muscle effectiveness. Implications for Cancer Survivors Body composition changes in patients after HSCT + TBI are apparent by early adult life and link with the risk of excess cardiometabolic morbidity seen in adult survivors. Interventions to improve muscle and/or adipose function, perhaps utilizing nutritional manipulation and/or targeted activity, should be investigated.