Hypothyroidism in induction chemotherapy of children with acute lymphoblastic leukaemia: A single-centre study
Abstract
Hypothyroidism as a long-term complication in cancer survivors has been an issue, but few studies have focused on changes in thyroid hormone levels during chemotherapy for leukaemia. This retrospective study was conducted to assess the characteristics of children with acute lymphoblastic leukaemia (ALL) and hypothyroidism during induction chemotherapy and to investigate the prognostic value of hypothyroidism in ALL. Patients with a detailed thyroid hormone profile at ALL diagnosis were enrolled. Hypothyroidism was defined as low serum levels of free tetraiodothyronine (FT4) and/or free triiodothyronine (FT3). The Kaplan-Meier method was used to create survival curves, and multivariate Cox regression analysis was used to screen prognostic factors associated with progression-free survival (PFS) and overall survival (OS). There were 276 children eligible for the study, and 184 patients (66.67%) were diagnosed with hypothyroidism, including 90 cases (48.91%) with functional central hypothyroidism and 82 cases (44.57%) with low T3 syndrome. Hypothyroidism was correlated with the dosages of L-Asparaginase (L-Asp) (P = .004) and glucocorticoids (P = .010), central nervous system (CNS) status (P = .012), number of severe infections (grade 3, 4 or 5) (P = .026) and serum albumin level (P = .032). Hypothyroidism was an independent prognostic factor for PFS in ALL children (P = .024, 95% CI: 1.1-4.1). We conclude that hypothyroidism is commonly present in ALL children during induction remission, which is related to chemotherapy drugs and severe infections. Hypothyroidism was a predictor of poor prognosis in childhood ALL.
Graphical Abstract
What's new?
Hypothyroidism is a recognised long-term complication in childhood acute lymphoblastic leukaemia survivors. However, little is known about the changes in thyroid hormone levels during chemotherapy. This retrospective study found that hypothyroidism was commonly present in paediatric patients with acute lymphoblastic leukaemia during induction chemotherapy, mainly under the form of functional central hypothyroidism and low T3 syndrome. Hypothyroidism was associated with the chemotherapy drug dosages of L-asparaginase and glucocorticoids. Children with hypothyroidism were more likely to suffer hypoalbuminemia and severe infections. Hypothyroidism was a predictor of poor prognosis in children with acute lymphoblastic leukaemia.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data generated for this study are available from the corresponding author upon reasonable request.
