The Effect Of Glucocorticoid On Leptin And Body Mass Index In The Treatment Of Acute Lymphoblastic Leukemia

Objective To assess whether the changes of serum leptin level caused by glucocorticoid is associated with obesity, leptin levels, body mass index(BMI) were measured before and after the induction, delayed enhancement and maintenance chemotherapy in children with ALL, so as to predict changes in body weight during and after chemotherapy, adjust the dose of and duration of chemotherapeutics.Methods 33 cases of standard-risk-ALL diagnosed by bone marrow morphology and immunophenotyping in Pediatric Department, General Hospital of Ningxia Medical University from January 2014 to December 2015 were enrolled in this study. Their height and weight were measured,and BMI was calculated. Levels of serum leptin were measured by ELISA in before and after induction, delayed intensification and maintenance. SPSS13.0 software was used for statistical analysis and paired t test used for difference between groups. The correlation between BMI and leptin levels was analyzed by Pearson linear correlation analysis.Results1. During induction period, BMI(kg / m2) were 16.23 ± 1.24, 17.19 ± 1.28, 18.04 ± 1.58, 19.69±1.81,21.18 ± 1.73, respectively, before, 1w, 2w, 3w and 4w after application of dexamethasone(Dex), respectively, leptin levels(ng / ml) were: 3.29 ± 0.28, 6.39 ± 0.83, 8.04 ± 1.43, 11.55 ± 0.89, 13.78 ± 1.18, respectively. Paired t-test in each two groups showed statistically significant difference(p <0.05).2. During delayed intensification period, BMI(kg / m2) were T1 17.18 ± 1.14 and T2 18.77 ± 1.46 before and 1 week after the first round of Dex T3 19.46 ± 1.49 and T4 21.40 ± 1.66 before and 1 week after the second round of Dex. T1 and T2, T3 and T4 were compared by paired t test, respectively, and the difference was statistically significant(p <0.05). Leptin levels(ng / ml) were L1 4.17 ± 1.37, L2 7.51 ± 1.82 before and 1 week after the first round of Dex L3 7.51 ± 2.49 and L4 9.17 ± 1.951 before and 1 week after the second round of Dex. L1 and L2, L3 and L4 were compared by paired t test, respectively and the difference was statistically significant(p <0.05).3. During maintenance period, BMI and leptin levels(ng / ml) showed no statistically significant difference in every two months compared by paired t test(p> 0.05),4. BMI and leptin level was positively correlated, and the difference was statistically significant, r =0.817 p <0.05.Conclusion1. Glucocorticoids increases leptin levels in induction and delayed intensificationperiod while not in maintenance period in the treatment of acute lymphoblastic leukemia.2. Leptin level is positively correlated with BMI, and changes of leptin level caused byglucocorticoids is correlated with obesity in each period of chemotherapy3. Dex should be used as short as possible in treatment course, and the dosage shouldbe adjusted as long as it can ensure the therapeutic effect for children with ALL.