Obesity and Survival in a Cohort of Predominantly Hispanic Children With Acute Lymphoblastic Leukemia

Abstract

Acute lymphoblastic leukemia (ALL), the most common malignancy in children, constitutes 25% of all pediatric cancer. Childhood cancer patients who are obese at diagnosis represent a particular challenge for the oncologist. Obesity may complicate chemotherapy dose determination, and has been associated with decreased overall and event-free survival in a number of adult cancer patients, and more recently in pediatric patients. The purpose of the present study was to examine whether obesity at diagnosis was associated with decreased overall and event-free survival in a cohort of 322 predominantly Hispanic pediatric patients with B-precursor ALL. Obesity was classified as an age-standardized and sex-standardized body mass index z-score at or above the 95th percentile. Hazard ratios (HRs) for overall and event-free survival were assessed using Cox proportional hazards regression modeling. Obesity at diagnosis was not associated with decreased overall survival (HR = 1.40, 95% confidence interval = 0.69-2.87) or event-free survival (HR = 1.08, 95% confidence interval = 0.65-1.82) in the overall cohort or in either of the 2 age-at-diagnosis (2 to 9 y; 10 to 18 y) subgroups. Our finding of no obesity-related prognostic effect in the overall cohort and in the under 2 to 9-year age-at-diagnosis cohort was consistent with the previous large-scale study of ALL patients; the absence of a prognostic effect in the 10 to 18-year age-at-diagnosis cohort, however, conflicted with previous findings.

Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia

“…Of note, the study included a predominantly Hispanic population on the basis of institutional demographics (n 5 157/198 [79.3%]). As previously reported nationally 27 and in a recent ALL population, 28 obesity was more prevalent in our cohort in the Hispanic population. Consistent with national averages, obesity was more prevalent in our cohort in males, 27 adolescents (particularly †A single patient with unknown cytogenetics was excluded from this analysis.…”

“…The adverse impact of obesity beginning at time of diagnosis on EFS and disease-related mortality has been demonstrated across multiple studies in pediatric ALL, [2][3][4][5]28 adult ALL, 39 and other hematologic malignancies. [40][41][42] The newly identified effect of obesity to increase risk for persistent MRD raises the question of whether obese patients should be considered as a higher risk group from time of diagnosis, analogous to adolescents, who could potentially benefit from more intensive therapy during induction.…”

The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia

“…Studies that showed that baseline BMI was not associated with outcome included small numbers of patients in BMI subgroups, or only analyzed the influence of being overweight on survival. [5][6][7][8]13 Studies that reported baseline undernourishment as a determinant of impaired survival were mostly conducted in developing countries or had small numbers in the BMI subgroups. [9][10][11] In those series, patients were, in addition to their disease status and treatment, also coping with additional risk factors for poor outcome such as malnutrition and poor socioeconomic risk factors.…”

“…3 Previous studies in pediatric ALL showed contradictory results, i.e. some studies show that weight at diagnosis does not influence survival, while others suggest that being underweight or overweight at diagnosis of ALL has an influence on survival [4][5][6][7][8][9][10][11][12][13][14] (Table 1). Body composition changes extremely during the treatment of pediatric ALL due to the use of corticosteroids, 15,16 but also due to other factors such as the catabolic effect of the disease itself, stress, 17 nutritional changes and impaired exercise capacity.…”

The Role of Adipose Tissue and Obesity in Causing Treatment Resistance of Acute Lymphoblastic Leukemia

“…Two of the studies acknowledged that their failure to detect an association between BMI and ALL outcome may have been due to small sample size (16, 17). Interestingly, the risk estimates of overall survival and event-free survival from both studies showed a trend of worsened outcome in the overweight/obese patients.…”