Body mass index associated with childhood and adolescent high‐risk B‐cell acute lymphoblastic leukemia risk: A Children’s Oncology Group report

Abstract

Background Obesity is a risk factor for many adulthood cancers, but its role in childhood, adolescent, and young adult (AYA) cancer is unknown. Childhood and AYA acute lymphoblastic leukemia (ALL) incidence and obesity prevalence have shown concurrent increases. We sought to identify whether obesity may be a risk factor for childhood and AYA ALL. Methods Characteristics from individuals with ALL, aged 2‐30 years, diagnosed 2004‐2017 and treated on Children's Oncology Group (COG) protocols with available pre‐treatment anthropometric data (N = 4726) were compared to National Health and Nutrition Examination Survey controls (COG AALL17D2). Body mass index (BMI) was defined using standard CDC definitions. Multivariate conditional logistic regression assessed associations between BMI and ALL with additional analyses stratified by sex and race/ethnicity. Results Among cases (72% high‐risk (HR) B‐ALL, 28% T‐ALL), 5% had underweight, 58% normal weight, 17% overweight, and 20% obesity. Underweight (OR 2.11, 95% CI 1.56‐2.85) and obesity (OR 1.32, 95% CI 1.15‐1.53) were associated with B‐ALL diagnosis. Specifically, obesity was associated with B‐ALL among males (OR 1.57, 95% CI 1.30‐1.91) and Hispanic children (OR 1.78, 95% CI 1.39‐2.29). Obesity was also associated with central nervous system (CNS) involvement. Conclusion Pre‐treatment obesity is associated with HR B‐ALL among males and Hispanics, as well as with CNS involvement, suggesting common physiology between obesity and leukemogenesis. An association between underweight and ALL was confirmed, likely due to cancer‐associated wasting. These results have important public health implications for obesity prevention and treatment in children and adolescents to reduce cancer risk.

Diet as a Potential Moderator for Genome Stability and Immune Response in Pediatric Leukemia

“…In fact, fetal embryo cord blood from obese mothers had different gene expression profiles, including changes in immune and inflammatory signaling, compared to controls [ 51 ]. In a population of about 5000 ALL patients between the ages of 2 and 20, obesity before treatment was identified to associate with high risk B-ALL, in Hispanic and male populations more than others [ 52 ]. These associations also hold in some animal models of ALL.…”

Anthropometric indicators associated with childhood obesity. Is it time for a BMI successor?

“…Badania wykazały, że kilka onkogenów zostało powiązanych z zapaleniem i rozwojem nowotworów. Środowisko zapalne obserwowane podczas otyłości wydaje się sprzyjać proliferacji i przeżyciu komórek nowotworowych [14, 16,17] co sugeruje silny związek między wyższym wskaźnikiem masy ciała w okresie dojrzewania a zwiększonym ryzykiem występowania tego typu chorób w wieku dorosłym. Autorzy przedstawiają korelację między wyższym wskaźnikiem masy ciała (BMI) w okresie dojrzewania a zwiększonym ryzykiem zapadalności na nowotwory złośliwe m.…”

“…in. : ostrą białaczkę limfoblastyczną [17], raka jelita grubego [11], raka piersi [18]. Ostatecznie podkreślany jest również związek między otyłością dziecięcą a ryzykiem przedwczesnego zgonu ze wszystkich przyczyn [19].…”

Caloric and nutrient restriction to augment chemotherapy efficacy for acute lymphoblastic leukemia: the IDEAL trial

“…[1][2][3] The adverse impact of obesity on cancer outcome has been well described for B-cell acute lymphoblastic leukemia (ALL; B-ALL), [4][5][6][7][8] the most common pediatric malignancy. Moreover, preexisting obesity is associated with increased risk of developing B-ALL during childhood 9 wherein up to 40% of children and adolescents begin ALL therapy overweight or obese (OW/OB). 9,10 Prolonged glucocorticoid chemotherapy and sedentary behavior during the first month of therapy (induction) further compound this problem by causing rapid gains in fat.…”

“…Moreover, preexisting obesity is associated with increased risk of developing B-ALL during childhood 9 wherein up to 40% of children and adolescents begin ALL therapy overweight or obese (OW/OB). 9,10 Prolonged glucocorticoid chemotherapy and sedentary behavior during the first month of therapy (induction) further compound this problem by causing rapid gains in fat. 10,11 Being obese during therapy for National Cancer Institute (NCI)/Rome high-risk B-ALL (HR-ALL) confers a 50% greater risk for relapse and poorer survival in children and adults.…”