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Analysis of lipid profile changes in acute leukemia patients at different stages of pathogenetic therapy

Praskurnichy EA3,Dzidzariia VO1*and Kitaeva Yu S2

1Federal State Budgetary Institution of the Russian Federation "State Research Center of the Russian Federation - Federal Medical Biophysical Center named after A.I. Burnazyan" of the Federal Medical and Biological Agency, Moscow
2Federal State Budgetary Institution of Higher Education "Ural State Medical University" of the Ministry of Health of the Russian Federation, Yekaterinburg
3Federal State Autonomous Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Moscow

*Corresponding author

*Dzidzariia VO, Federal State Budgetary Institution of the Russian Federation "State Research Center of the Russian Federation - Federal Medical Biophysical Center named after A.I. Burnazyan" of the Federal Medical and Biological Agency, Moscow

Abstract

Patient survival with acute leukemia (AL) has significantly improved with the advent of modern treatment modalities. However, pathogenetic
therapy for AL, which includes high-dose chemotherapy (HDCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT), is a major intervention that has a toxic effect on various metabolic processes, including the development of cardio-metabolic disorders and dyslipidemia.

Keywords:pathogenetic therapy, acute leukemia patients, high-dose chemotherapy, cardiologists.

Introduction

Patient survival with acute leukemia (AL) has significantly improved with the advent of modern treatment modalities. However, pathogenetic therapy for AL, which includes high-dose chemotherapy (HDCT) and allogeneic hematopoietic stem cell transplantation (allo-HSCT), is a major intervention that has a toxic effect on various metabolic processes, including the development of cardio-metabolic disorders and dyslipidemia [1]. The development of cardiovascular complications necessitates additional examination and diagnostic methods, as well as observation by specialized professionals, including cardiologists, with the aim of preventing cardiovascular complications and increasing the lifespan of patients in the post-transplant period. The issue of developing preventive measures for dyslipidemia in patients with AL remains open.

Objective: To conduct an analysis of lipid status changes in patients with AL at different stages of pathogenetic therapy.

2. Materials and Methods

The study included 129 patients, 99 of whom had a confirmed diagnosis of AL, and 30 individuals in the control group. The AL patients were divided into 3 groups: 30 patients with newly diagnosed AL, the second group consisted of 30 patients with a confirmed diagnosis of ALL who had received HDCT as pathogenetic therapy, and the third group consisted of 39 AL patients who had undergone allo-HSCT in addition to HDCT. All patients in the study groups and the control group underwent lipid profile analysis (total cholesterol, LDL, HDL, triglycerides (TG), VLDL, non-HDL, atherogenic index), biochemical assessment of liver function, and complete blood count.

3. Results

When evaluating the obtained data, statistically significant changes in the lipid profile were determined for cholesterol, TG, HDL, non-HDL cholesterol, and LDL in patients after pathogenetic therapy, which included HDCT and allo-HSCT. In this regard, patients after allo-HSCT showed significantly more frequent changes in cholesterol, HDL, non-HDL and LDL compared to the group that received only high-dose chemotherapy. When comparing patients with graft-versus-host disease who received allo-HSCT with the control group, significant changes in all lipid spectrum parameters were observed. Compared to the control group, significant changes in TG and atherogenic index were also observed in patients who received HDCT. Thus, it can be concluded that changes in the lipid spectrum are associated with the pathogenetic therapy administered, and patients with graft-versus-host disease have a higher risk of changes in lipid profile parameters, specifically cholesterol, TG, HDL, non-HDL and LDL.

Furthermore, the relationship between complete blood count parameters and changes in lipid status in patients with AL was determined. Specifically, a positive correlation was found between hemoglobin and cholesterol, HDL, non-HDL cholesterol and LDL, and a negative correlation with the atherogenic index. Erythrocyte indices (MCV, MCH) showed a positive correlation with cholesterol. A negative correlation was also determined between platelets and TG, atherogenic index, and VLDL. The obtained data may indicate the involvement of platelets and hemoglobin in lipid metabolism.

During the assessment of liver function, a correlation with changes in lipid metabolism was revealed: ALT with cholesterol, non-HDL, atherogenic index and HDL; AST with cholesterol, non-HDL, atherogenic index and HDL. The identification of a positive correlation between transaminase levels and cholesterol, LDL may suggest the development of liver dysfunction against the background of pathogenetic therapy with pro-atherogenic shifts. 

Discussion

Changes in lipid metabolism in patients with AL are actively studied from the perspective of the influence of the neoplastic process itself and the pathogenetic therapy applied. At the onset of the disease, a decrease in cholesterol and HDL levels is observed against the background of their active consumption by tumor cells, as well as a decrease in LDL, associated with its active absorption by leukemic cells [2]. The work by Cvetkovic Z et al. showed that after remission is achieved in patients with AL, normalization of lipid metabolism indicators occurs, which is also reflected in the results of our study [3].

According to the studied data, the development of anemia followed by hypoxia negatively affects the synthetic function of lipids by the liver [4]. A number of studies indicate a link between changes in the lipid spectrum and the severity of anemia [5]. Analyzing the obtained data, a relationship between cholesterol, HDL, and LDL values and hemoglobin levels, and cholesterol with erythrocyte indices is shown, while no connection with leukocyte indicators is determined. Thus, it can be concluded that changes in lipid metabolism are related to the erythroid lineage and are not related to the granulocytic lineage [6-8].

Conclusion

In patients with AL who received pathogenetic therapy, changes in lipid metabolism are observed, which are interconnected with hemogram values and liver function indicators. The development of lipid metabolism disorders during remission in AL patients can lead to cardiovascular diseases associated with the atherosclerotic process, which, in turn, can affect their quality and life expectancy.

REFERENCES

  1. Battiwalla M, Tichelli A, Majhail NS (2017) Long-Term Survivorship after Hematopoietic Cell Transplantation: Roadmap for Research and Care. Biol Blood Marrow Transplant 23(2): 184-192.
  2. Lu Y, Ma X, Pan J, Ma R, Jiang Y (2022) Management of dyslipidemia after allogeneic hematopoietic stem cell transplantation. Lipids Health Dis 21(1): 65.
  3. Cvetkovic Z, Cvetkovic B, Petrovic M, et al. (2009) Lipid profile as a prognostic factor in cancer patients. J BUON 14(3): 501-506.
  4. Maran L, Hamid A, Hamid SBS (2021) Lipoproteins as Markers for Monitoring Cancer Progression. J Lipid pp.
  5. Zhelobov VG (2018) The state of the blood lipid spectrum in patients with acute lymphoblastic leukemia during cytostatic therapy. Medical and pharmaceutical magazine "Pulse", 20(1): 170-174.
  6. Finch ER, Smith CA, Yang W, et al. (2020) Asparaginase formulation impacts hypertriglyceridemia during therapy for acute lymphoblastic leukemia. Pediatr Blood Cancer 67(1): e28040.
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  8. Kagoya Y, Seo S, Nannya Y, Kurokawa M (2012) Hyperlipidemia after allogeneic stem cell transplantation: prevalence, risk factors, and impact on prognosis. Clin Transplant 26(2): E168-E175.

JCMCRI
ISSN: 3064-8025

Journal of Clinical & Medical Case Reports, Images (JCMCRI) ISSN: 3064-8025 is a peer-reviewed journal dedicated to publishing clinical images from all sectors of medicine. The goal of this magazine is to disseminate information about new discoveries and treatments in science and medicine.

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