Chemotherapy-induced Diabetes Mellitus In Hematopoietic Malignancies

Part I A Retrospective Rtudy of Chemotherapy-induced Diabetes Mellitus in Patients Diagnosed with Acute Lymphoblastic LeukemiaObjective:To identify the incidence of chemitherapy-induced diabetes mellites(DM) in patients diagosed with acute lymphoblastic leukemia (ALL), analyze the risk factors for DM development and determine its effect on survival and disease remission.Method:One hundred fifty-six adult patients with previously no DM history who were initially diagnosed in our hospital from January2011to October2013were evaluated. Chemotherapy-induced DM was defined as≥2continuous fasting plasma glucose (FBG) determinations of≥7.0mmol/L during chemotherapy. The rate of complete remission, overall survival (OS) and event-free survival (EFS) were determind for patients with and without DM; differences between the two groups were assessed using standard statistic methods.Result:(1) Among the156patients enrolled, chemotherapy-induced DM was found to occur in17(10.9%) patients during the induction chemotherapy and33(21.2%) throughout all the chemotherapy cycles.43patients(27.6%) received hematopoietic stem cell transplantation(HSCT) and among them,10patients developed DM during the first45days transplantation.2patients were diagnosed DM months after HSCT.(2) we found that age≥35years (P=0.013) was independently significant factors associated with chemotherary-induced DM development by univariate analysis and multi-variate analysis.(3) After adjusting for the effect of age, patients with DM during the induction chemotherapy seemed to have a comparable CR rate with those had no DM.(4) For those younger than35, patients with DM had a shorter median OS (11.3months vs.>48months, P=0.002) and a shorter median EFS(9.1months vs.15.9months, P=0.005). In multivariable analysis, chemotherapy-induced DM was a prognostic factor for poor OS (P=0.000,HR5.922) and poor EFS (P=0.003, HR3.159);(5) For those older than35, we found no significant difference between two groups in OS and EFS(OS:P=0.989; EFS: P=0.635).Conclusion:Chemotherapy-induced DM is a major complication for ALL patients. Age was the independently significant factor associated with chemotherary-induced DM. For those younger than35, patients with DM experience a significant decrease in OS and Part Ⅱ Chemotherapy-induced diabetes mellitus in hematopoietic malignancies:a prospective studyObjective:To identify the incidence of chemotheropy-induced DM in patients with hematopoietic malignancies including acute myoloid leukemia(AML), acute dymphoblastic leukemia(ALL), lymohoma, multiple myeloma and myelodysplastic syndrome(MDS), analyze the risk factors for DM development and determine its effect on survival and disease remission. And on this base, we supposed to study the mechanism of chemotherapy-induced DM.Method:Inclusion criteria were:conformed hematopoietic malignancies according to WHO classification and NCCN guildlines; no previous treatment for hematopoietic malignancies and no history of DM, age14-80. We excluded patients who were diagnosed of DM after2h-OGTT, patients with other cancers,patients who didn’t accept chemotherapy after diagnosis of hematopoietic malignancies and those could not understant or comply with protocol. Oral glucose tolerance testing was proceeded in all the enrolled patients and the glucose metabolism indicators such as fasting insulin, fasting C-peptide were tested before the first cycle of chemotheropy and after the initiation of DM. Diagnosis of DM was performed according to the American Diabetes Association’s criteria.Result:We enrolled165patients, of whom109were included in the analysis.30of the109patients were diagnosed with AML,12patients were diagnosed with ALL,36with NHL,7with HL,4with MDS and19with MM. The median follow-up was4.6months. Among the109patients,8(7.3%) developed DM with3cases of ALL(25.0%),4cases of NHL(11.1%) and1case of AML. At the end of follow-up,3of the8patients with DM had died.Conclusion:Compared with AML, HL,MDS and MM, patients with ALL and NHL were more likely to develop DM during chemotherapy. Patients with chemotherapy-induced DM may experience increased overall mortality.