Glycemic Variability and Pediatric Hematopoietic Stem Cell Transplantation

Glycemic variability appeared to be a risk factor for morbidity in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT), according to results of a study published in Pediatric Blood & Cancer.

The study was a retrospective analysis of patient records from the Children’s Hospital Colorado system. Outcomes and potential risk factors for 344 patients aged 0 to 30 years were analyzed with respect to blood glucose coefficients of variation (CVs) from the 14 days prior to first HSCT and the first 30 days following the procedure. Glucose CV was used as an indicator of glycemic variability.

Glucose CV was elevated above the reportedly healthy range for adults in 38% of patients prior to HSCT, and in 33% of cases following HSCT. The median glucose CVs pre- and post-HSCT, were 17.8%, and 15.5%, respectively.

In multivariate analysis, the hazard ratio (HR) for infection was found to be 4.91 times higher (95% CI, 1.40-17.24) with each doubling of glucose CV in the pre-HSCT phase. Pre-HSCT glucose CV was also an independent risk factor for time spent in intensive care among recipients of allogeneic HSCT (HR, 1.65; 95% CI, 1.15-2.35).

The type of HSCT showed nonsignificant trends with mortality in relation to glucose CV in multivariate analyses. Among patients who received allogenic HSCT, the HRs for mortality were 1.40 (95% CI, 0.98-1.99) with each doubling of glucose CV pre-HSCT and 1.38 (95% CI, 0.996-1.91) post-HSCT. For autologous HSCT, these rates were 0.90 (95% CI, 0.64-1.26) and 0.75 (95% CI, 0.48-1.15), respectively.

Factors that were independently linked to glucose CV in the period before HSCT included a history of asparaginase treatment and a nonmalignant indication for HSCT. After HSCT, higher glucose CV was linked to pre-HSCT radiation to the pancreas, a history of insulin treatment, allogeneic HSCT, steroid therapy during the period after HSCT, and total parenteral nutrition following HSCT.

The researchers aimed to draw attention to the possible consequences associated with glycemic variability, which is a factor that may be less readily apparent than are hyperglycemia or hypoglycemia. “In summary, glycemic variability is a common occurrence in the pediatric HSCT population and is associated with increased risk of infection and critical illness in HSCT patients,” concluded the researchers.

Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures

Reference

Sopfe J, Campbell K, Keating AK, et al. Glycemic variability is associated with poor outcomes in pediatric hematopoietic stem cell transplant patients. Pediatr Blood Cancer. Published online August 16, 2020. doi:10.1002/pbc.28626