Population‐Based Assessment of Cardiometabolic Late Effects in 5‐Year Survivors of Pediatric Acute Lymphoblastic Leukemia

INTRODUCTION: Survival rates for pediatric acute lymphoblastic leukemia (ALL) have improved substantially, shifting attention toward long-term health. Epidemiologic data on survivors of pediatric ALL from large, population-based cohorts, particularly in early survivorship, is limited. We addressed this gap by examining the prevalence of diagnosed cardiometabolic conditions among pediatric ALL survivors compared with matched cancer-free peers during the fifth year after diagnosis. METHODS: We conducted a retrospective cohort study using linked data from the Arkansas Central Cancer Registry (2013-2020) and Arkansas All-Payer Claims Database (2017-2024). Individuals diagnosed with ALL before age 25 years who survived to the fifth year after diagnosis were identified. We matched ALL survivors with three cancer-free peers by exact matching on sex, race, ethnicity, birth year, Medicaid enrollment history, and county of residence. Cardiometabolic outcomes were identified using claims-based diagnoses among the ALL survivors and matched controls. We examined differences in cardiometabolic outcomes between ALL survivors and matched controls. RESULTS: ALL survivors (n = 142; age range 4-30 years) experienced a significantly higher burden of cardiometabolic conditions compared with matched controls (n = 426; 10.6% vs. 1.2%, p < 0.01). ALL survivors had higher prevalence of hypertension (4.9% vs. 0.9%; p < 0.01) and diabetes mellitus (4.9% vs. 0.2%; p < 0.01). Differences were more pronounced among ALL survivors aged ≥ 14 years, among whom 20.4% (vs. 2.0%; p < 0.01) had at least one cardiometabolic condition. CONCLUSIONS: Pediatric ALL survivors experience elevated cardiometabolic risk as early as five years after diagnosis, particularly during adolescence. Early screening and preventive strategies are needed to reduce long-term cardiometabolic burden among pediatric ALL survivors.