Obesity but not overweight increases the incidence and mortality of leukemia in adults: A meta-analysis of prospective cohort studies

Castillo, Jorge J.; Reagan, John L.; Ingham, Randall R; Furman, Michael; Dalia, Samir; Merhi, Basma; Nemr, Saed; Zarrabi, Ali John; Mitri, Joanna

doi:10.1016/j.leukres.2011.12.020

Cited by 112 publications

(105 citation statements)

References 42 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Orgel

Tucci

Alhushki

et al. 2014

Blood

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Obesity is associated with poorer event-free survival (EFS) in pediatric acute lymphoblastic leukemia (ALL). Persistent minimal residual disease (MRD) in the bone marrow as measured by multidimensional flow cytometry (MDF) is a key early prognostic indicator and is strongly associated with EFS. We therefore hypothesized that obesity during induction would be associated with positive end-of-induction MRD ( ‡0.01%). We analyzed MDF of end-induction bone marrow samples from a historical cohort of 198 children newly diagnosed with B-precursor ALL (BP-ALL) and treated with Children's Oncology Group induction regimens. We assessed the influence of body mass index on risk for positive end-induction MRD in the bone marrow. In our cohort of BP-ALL, 30 children (15.2%) were overweight and 41 (20.7%) were obese at diagnosis. Independent of established predictors of treatment response, obesity during induction was associated with significantly greater risk for persistent MRD (odds ratio, 2.57; 95% confidence interval, 1.19 to 5.54; P 5 .016). Obesity and overweight were associated with poorer EFS irrespective of end-induction MRD (P 5 .012). Obese children with newly diagnosed BP-ALL are at increased risk for positive end-induction MRD and poorer EFS. (Blood. 2014;124(26):3932-3938)

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Section: Discussionmentioning

confidence: 99%

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

Orgel

Tucci

Alhushki

et al. 2014

Blood

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“…Epidemiologic studies frequently have used BMI to define obesity and explore its association with cancer risk and mortality (2)(3)(4). In adults, studies repeatedly have demonstrated that a higher BMI is positively associated with both the incidence of leukemia (4,5) and leukemia-related mortality (3,5). In children, controversy remains about whether and how childhood obesity might similarly affect leukemia therapy and survival.…”

Section: Introductionmentioning

confidence: 99%

Association of body mass index and survival in pediatric leukemia: a meta-analysis

Orgel

Genkinger²,

Aggarwal

et al. 2016

The American Journal of Clinical Nutrition

131

111

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Background: Obesity is a worldwide epidemic in children and adolescents. Adult cohort studies have reported an association between higher body mass index (BMI) and increased leukemiarelated mortality; whether a similar effect exists in childhood leukemia remains controversial. Objective: We conducted a meta-analysis to determine whether a higher BMI at diagnosis of pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) is associated with worse event-free survival (EFS), overall survival (OS), and cumulative incidence of relapse (CIR). Design: We searched 4 electronic databases from inception through March 2015 without language restriction and included studies in pediatric ALL or AML (0-21 y of age) reporting BMI as a predictor of survival or relapse. Higher BMI, defined as obese ($95%) or overweight/obese ($85%), was compared with lower BMI [nonoverweight/obese (,85%)]. Summary risk estimates for EFS, OS, and CIR (ALL only) were calculated with random-or fixed-effects models according to tests for between-study heterogeneity. Results: Of 4690 reports identified, 107 full-text articles were evaluated, with 2 additional articles identified via review of citations; 11 articles were eligible for inclusion in this meta-analysis. In ALL, we observed poorer EFS in children with a higher BMI (RR: 1.35; 95% CI: 1.20, 1.51) than in those at a lower BMI. A higher BMI was associated with significantly increased mortality (RR: 1.31; 95% CI: 1.09, 1.58) and a statistically nonsignificant trend toward greater risk of relapse (RR: 1.17; 95% CI: 0.99, 1.38) compared with a lower BMI. In AML, a higher BMI was significantly associated with poorer EFS and OS (RR: 1.36; 95% CI: 1.16, 1.60 and RR: 1.56; 95% CI: 1.32, 1.86, respectively) than was a lower BMI. Conclusion: Higher BMI at diagnosis is associated with poorer survival in children with pediatric ALL or AML.Am J Clin Nutr 2016;103:808-17.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] More than 200 studies have evaluated the relationship between body weight and cancer risk. Evidence has demonstrated that obese individuals are at greater risk of developing cancer.…”

Section: Introductionmentioning

confidence: 99%

Recommendations for Obesity Clinical Trials in Cancer Survivors: American Society of Clinical Oncology Statement

Ligibel

Alfano

Hershman

et al. 2015

JCO

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Obesity but not overweight increases the incidence and mortality of leukemia in adults: A meta-analysis of prospective cohort studies

Cited by 112 publications

References 42 publications

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

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

Association of body mass index and survival in pediatric leukemia: a meta-analysis

Recommendations for Obesity Clinical Trials in Cancer Survivors: American Society of Clinical Oncology Statement

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