Population‐Based Assessment of Cardiometabolic Late Effects in 5‐Year Survivors of Pediatric Acute Lymphoblastic Leukemia
Paige V. Strebeck, Aygul Tarlan, Kelsey M. Owsley, Ellen van der Plas, Jason E. Farrar, Clare C. Brown, Lauren E. AppellABSTRACT
Introduction
Survival rates for pediatric acute lymphoblastic leukemia (ALL) have improved substantially, shifting attention toward long‐term health. Epidemiologic data on survivors of pediatric ALL from large, population‐based cohorts, particularly in early survivorship, is limited. We addressed this gap by examining the prevalence of diagnosed cardiometabolic conditions among pediatric ALL survivors compared with matched cancer‐free peers during the fifth year after diagnosis.
Methods
We conducted a retrospective cohort study using linked data from the Arkansas Central Cancer Registry (2013–2020) and Arkansas All‐Payer Claims Database (2017–2024). Individuals diagnosed with ALL before age 25 years who survived to the fifth year after diagnosis were identified. We matched ALL survivors with three cancer‐free peers by exact matching on sex, race, ethnicity, birth year, Medicaid enrollment history, and county of residence. Cardiometabolic outcomes were identified using claims‐based diagnoses among the ALL survivors and matched controls. We examined differences in cardiometabolic outcomes between ALL survivors and matched controls.
Results
ALL survivors ( n = 142; age range 4–30 years) experienced a significantly higher burden of cardiometabolic conditions compared with matched controls ( n = 426; 10.6% vs. 1.2%, p < 0.01). ALL survivors had higher prevalence of hypertension (4.9% vs. 0.9%; p < 0.01) and diabetes mellitus (4.9% vs. 0.2%; p < 0.01). Differences were more pronounced among ALL survivors aged ≥ 14 years, among whom 20.4% (vs. 2.0%; p < 0.01) had at least one cardiometabolic condition.
Conclusions
Pediatric ALL survivors experience elevated cardiometabolic risk as early as five years after diagnosis, particularly during adolescence. Early screening and preventive strategies are needed to reduce long‐term cardiometabolic burden among pediatric ALL survivors.