**2. The lipid profile evolution under cancer treatment**

Cvetkovic & al. studied 47 patients with malignant non-Hodgkin's lymphoma (NHL) and found that before the treatment, compared with patients in the control group, blood levels of phospholipids, cholesterol (CH) and high density lipoprotein-cholesterol (HDL-cholesterol) had significantly lower values. After chemotherapy (3 or 6 cycles) the blood lipid levels reached even lower values in patients where the disease progressed, as opposed to those who achieved complete remission or whose disease was stationary, cases in which lipids increased progressively. (Cvetkovic et al., 2009).

In an other study conducted in Poland on the lipid levels of 238 patients with different hematological malignant diseases Kuliszkiewicz-Janus M et al. found that HDL-cholesterol values were significantly different from those of patients in the control group when the disease was in active phase, but in the remission phase the difference was statistically significant only in patients with NHL and acute leukemia (Kuliszkiewicz-Janus et al., 2008).

Cholesterol and Triglycerides Metabolism Disorder in Malignant Hemopathies 393

remained lower than for the control group. The main serum TG level was significantly

A retrospective analysis showed that imatinib mesylate, used for the treatment of patients with chronic myeloid leukemia, led to a diminishing of serum CH and TG values (Franceschino et al., 2008). In a Romanian patient with chronic myeloid leukemia who received usual-dose of imatinib mesylate, a rapid and sustained normalization of serum CH, TG, low- and high-density lipoproteins and glucose values was found (Gologan et al., 2009). In some types of leukemia it was found that Kit receptor tyrosine kinase is overexpressed in a pathological manner, also that CH depletion was able to prevent Kit-mediated activation of the phosphatidylinositol 3-kinase downstream target Akt, which inhibits cell proliferation

The treatment of cutaneous lymphomas with T cells using bexarotene can produce a serum TG augmentation, as in the three cases reported. The treatment with fenofibrate is recommended, but if adverse effects occure or a statin is needed to reduce hypertriglyceridemia, omega-3 fatty acids may be a therapeutic solution during the

**4. Is the metabolic syndrome a risk factor for some malignant hemopathies?**  The main risk factors for excess weight and obesity are high caloric diet and sedentary lifestyle. A study conducted in a county hospital in Transylvania examined the presence of MS in all 56 patients with NHL existing in its records and a control group of 64 consecutive patients with non-cancerous diseases in the same hospital (control group). Patients with NHL had significantly more frequently arterial hypertension, significantly higher body mass index values, and a significantly higher number of components of the MS as compared to those of the control group. This observation advocates the idea that excess weight may be

In a group of 170 non-Hispanic white pediatric cancer survivors, among males, body adiposity was more important in survivors than in witnesses, as was trunk fat. The survivors had higher values of CH, TG, LDL-cholesterol than the witnesses, and the first watched TV more hours than controls (Miller TL et al., 2010). It was observed that the young survivors of ALL, disease which they had in their childhood, especially those who received cranial radiotherapy, are likely to develop hyperlipidemia, insulin resistance, obesity,

After an average period of 37 months after the end of type ALL-BFM 90 chemotherapy protocol, out of 52 patients almost half were overweight, nearly 6% - obese, more than half

It was found that the consequences of treatment performed for ALL during childhood may become manifest when subjects reach adulthood. Cranial irradiation favors more the appearance of MS: 60% of those who had been so treated had at least two of the five components of MS when they become adults, and only 20% of those who had not been irradiated. The pathogenetic mechanism that explains the metabolic effects of cranial irradiation implies growth hormone (GH) deficiency, lower level of insulin-like growth factor 1, fasting hyperinsulinemia, abdominal obesity and hyperlipidemia, especially in women (Gurney et al., 2006). In another study, ALL survivors who received cranial irradiation developed more frequently MS than those nonirradiated (23% towards 7%), probably because

of higher prevalence of excess weight and arterial hypertension (van Waas et al., 2010).

arterial hypertension and even MS soon after the treatment (Trimis et al., 2007).

had at least one risk factor for MS, and about 6% had MS (Kourti et al., 2005).

higher as compared to that of witnesses (Zalewska-Szewczyk et al., 2008).

(Jahn et al., 2007).

bexarotene administration. (Musolino et al., 2009)

a risk factor for this type of neoplasia. (Mihăilă et al., 2009)

In a health investigation conducted on 156,153 subjects, with 5079 incident cancers in men and 4738 cancers in women, and a mean of 10.6 years of survey, there was an inverse association between serum triglyceride (TG) levels and NHL (2). But in the study conducted by Kuliszkiewicz-Janus M et al., the TG value increased in the active disease period in all the hematological malignancies besides NHL (Kuliszkiewicz-Janus et al., 2008).

Mihăilă R and al. made a cross-sectional research on all the patients with chronic lymphocytic leukemia (CLL) existing in a county department of hematology and a group of volunteer subjects from the medical staff with no malignant pathology. They found an augmentation of TG values in the patients with CLL (p <0.00001), an argument for a possible link between the MS and chronic lymphoproliferations. Hypercholesterolemia present in the patients with CLL from the above study may have consequences regarding the multiple drug resistance, subject to further future study. (Mihăilă et al., 2010)

Nearly all the children with ALL when diagnosed and during chemotherapy revealed a predictable model of serum dyslipidemia that consisted of very low levels of HDLcholesterol, and elevated TG, and low-density lipoprotein cholesterol (LDL-cholesterol), that regained normal values during the remission period (Moschovi et al., 2004).

In patients with secondary hemophagocytic syndrome an augmentation of TG was observed when diagnosed or during the disease period and TG values decreased when the disease improved under treatment (Okamoto et al., 2009). In patients with aggressive T cell lymphoma, fasting TG level was higher in those with hemophagocytic syndrome group than in the patients who had no hemophagocytic syndrome (Tong et al., 2008).
