Pilot study of vascular health in survivors of osteosarcoma

Background: Cardiovascular-related toxicities have been reported among survivors of osteosarcoma. Methods: Fasting blood samples from 24 osteosarcoma survivors were analyzed for high-sensitivity C-reactive protein (hsCRP), triglycerides, total cholesterol, high-density lipoprotein (HDL), apolipoprotein-ß, lipoprotein (a), fibrinogen, circulating endothelial cells (CECs), and surface expression of vascular cell adhesion molecule-1 (VCAM-1). Values were compared to subjects in the natural history Coronary Artery Risk Development in Young Adults (CARDIA) cohort study except for CECs and VCAM-1 expression, which were compared to controls studied at the University of Minnesota Lillehei clinical trials unit. Procedure: Survivors (54.2% male), median age 18 years (9-32) at diagnosis, 36.5 years (20-56) at evaluation were treated with a variety of chemotherapeutic exposures, all but one were exposed to doxorubicin (median dose 450mg/m²; range: 90-645mg/m²), 14 (58.3%) received cisplatin, and 3 (12.5%) were exposed to carboplatin. Two survivors (8.3%) received radiation therapy for disease relapse. Compared to CARDIA subjects, mean hsCRP (3.0mg/L±2.0 vs. 1.6±2.3), triglycerides (151mg/dl±81.7 vs. 95.4±101.3), lipoprotein (a) (34.9mg/dl±17.7 vs. 13.8±22.0), and fibrinogen (315.0mg/dl±49.3 vs. 252.4±61.7) were significantly elevated. The number of CECs (0.47cells/ml±2.5 vs. 0.92±2.5) did not differ while surface expression of VCAM-1 (86.4%±34.0 vs. 42.1±33.8) was significantly elevated compared to controls. Conclusions: Among survivors of osteosarcoma, assessed a median of 14 years from diagnosis, there is evidence of vascular inflammation, dyslipidemia, and early atherogenesis. Pediatr Blood Cancer 2013;60:1703-1708.