Endocrine Effects of Cancer Treatment in Female ALL Survivors

Acute lymphoblastic leukemia (ALL) is a type of cancer that primarily affects children and adolescents. While advancements in treatment have improved survival rates, there are significant long-term health implications for survivors, particularly concerning endocrine health. This study investigates the long-term endocrine and gonadal effects of chemotherapy and radiotherapy in female ALL patients, revealing important insights into their metabolic health and reproductive potential. In this cohort study, 51 female patients diagnosed with ALL between 2000 and 2020 were evaluated, with a mean age of 14.7 years at the time of participation and an average of 9.4 years since treatment completion. The findings were concerning, as 39.2% of participants exhibited at least one endocrine disorder, with dyslipidemia, insulin resistance, and obesity being the most prevalent. Specifically, low levels of Anti-Müllerian hormone (AMH), a marker of ovarian reserve, were observed in 41.6% of the patients, particularly those who underwent bone marrow transplantation. A significant positive correlation (p < 0.001, r = 0.612) was found between the time elapsed since treatment and AMH levels, suggesting that while some recovery may occur over time, intensive treatments can have lasting effects on reproductive health. These findings have practical implications for female ALL survivors. Regular monitoring of metabolic health markers, including fasting insulin and lipid profiles, is crucial for early detection of endocrine disorders. Survivors should be educated about the potential risks of obesity and insulin resistance, which can lead to further complications such as metabolic syndrome. Nutritional interventions, including a balanced diet and physical activity, can play a vital role in managing these risks and promoting overall health. The study's findings connect to several biomarkers relevant to metabolic health. For instance, monitoring fasting insulin levels can help assess insulin resistance, while lipid profiles (triglycerides, HDL, LDL) can indicate dyslipidemia. The presence of low AMH levels also highlights the importance of reproductive health assessments in this population. Utilizing Metabolicum's calculators for these biomarkers can aid survivors in tracking their metabolic health over time. In conclusion, this study underscores the need for long-term follow-up and monitoring of endocrine health in female ALL survivors. With a significant proportion experiencing endocrine complications, proactive health management strategies are essential. Survivors should engage with healthcare providers to develop personalized health plans that address their unique risks and promote metabolic well-being.