Recently I had a young man, who was an AML survivor, present with a triglyceride level of 5800. Usually, my first thought would be that there was a genetic abnormality leading to ineffective cholesterol metabolism. But, I was aware of breast cancer survivors being at risk for dyslipidemia and I began to wonder about leukemics. I then went on a literature search. What I found was quite interesting.

AML has a cure rate of nearly 97%. Therefore, most patients who get it live to tell about it. In terms of what their mortality is after their cure, the literature shows it is divided between heart disease and new malignancies.

In terms of heart disease, they are at risk from dyslipidemia and the metabolic syndrome. Even more interesting is that patients who have had a bone marrow transplant are particularly at risk. In a review article from the journal "Bone Marrow Transplantation"( Majhail et al. June 2008), 86 bone marrow transplant patients were followed. 49% of them were found to have metabolic syndrome. The rate of hypertension and hypertriglyceridemia was significantly higher in them as well. Therefore, I have hypothesized that this young man's high triglyceride level was related to his bone marrow transplant.

The patient and his family ended up calling his transplant center and they agreed that this is a known potential side effect.

I think this case points to the importance of primary care follow up of all cancer survivors. Often cancer patients have to deal with so many issues regarding their cancer that regular primary care issues take the back burner. They take the back burner, that is, until these regular primary care issues land them in the hospital!