Table 1.
Rates of Obesity at Acute Lymphoblastic Leukemia (ALL) Diagnosis, End of Treatment, and During Follow-up.
| Author (Reference) | Study Design | Populations | Protocols | Findings |
|---|---|---|---|---|
| Van Dongen-Melman et al. [34] | RCR |
n = 113 Age: 0.5–15 years |
Overweight/obese patients (>90th BMI percentile) constituted 7.9% (n = 9) of the sample at diagnosis. At the end of therapy, 30% (n = 34) were overweight/obese. At four years after treatment completion, 23.9% (n = 27) were overweight/obese. Radiotherapy was not associated with obesity. Patients who received a combination of dexamethasone and prednisone were at the highest risk of being obese (44%). Higher cumulative steroid dose did not contribute to more obesity. | |
| Withycombe et al. [35] | RCR |
n = 1638 Age: 2–20 years |
COG (CCG 1961) | Obesity rates in children with high risk ALL were 14% at baseline and 23% at the end of treatment. Females, Black or Hispanic, and age 5–9-year-old, but not cranial irradiation, were risk factors. The highest increase in BMI% was between maintenance phases 1–3, 9–12 months postdiagnosis. (Induction BMI% 7.2, BMI% 12.6 by maintenance phase 3). |
| Breene et al. [36] | RCR |
n = 77 Age: 1–16 years |
MRC UKALL97 protocol | Whole group: Patients received only chemotherapy and no CRT. Thirty patients (39%) received prednisolone, and 47 (61%) got dexamethasone. Weight gain was not linked to steroids. There was a significant rise in BMI-SDS from diagnosis (0.35, 95% CI 0.20–0.50) to the end of treatment (1.29, 95% CI 1.13–1.45, p < 0.0001), and at three-year follow-up (1.04, 95% CI 0.85–1.22, p <0.0001). More survivors were overweight or obese at three years post treatment (25/53, 47.20%) when compared to diagnosis (23/77, 29.90%), (p-value 0.01) Female subgroup: Significant rise in BMI-SDS from diagnosis (0.46, 95% CI 0.27–0.64), at end of treatment (1.46, 95% CI 1.26–1.66, p < 0.0001) and at three-year follow-up (1.24, 95% CI 1.03–1.45, p < 0.0001) Male subgroup: Significant rise in BMI-SDS from diagnosis (0.24, 95% CI 0.01–0.46), to end of treatment (1.11, 95% CI 0.85–1.36, p < 0.0001) and at three-year follow-up (0.77, 95% CI 0.43–1.10, p < 0.0001) |
| Razzouk et al. [37] | RCS |
n = 248 Age < 19 years At diagnosis, 13.2–30 years at the latest assessment |
Chemotherapy-Total Therapy Study X protocol | The prevalence of overweight/obesity in 0–6-year-old (6%) was lower than that in the 13–19-year-old group (19%) at diagnosis. At adult height attainment, the prevalence of overweight/obese in 0-6 years of age at diagnosis was 41%, versus 13–19 years of age at 35%. These rates are close to the USA’s general population. Those <6 years of age (OR 2.3, 95% CI 1.2–4.2, p-value 0.01), male (OR 0.50, 95% CI 0.28–0.91, p-value 0.02), and being overweight/obese at diagnosis (OR 14.00, 95% CI 5.00–39.00, p-value < 0.0001) were predictors of obesity at adult height attainment. CRT (24 Gy) led to an increase in BMI trajectory, but this was not different from the 18 Gy CRT group. |
| Ghosh et al. [38] * | RCS |
n = 4775 Age: 2–30 years Age, sex, and ethnicity-matched controls from NHANES |
COG AALL17D2 |
Newly diagnosed had overweight rates of 17% and obesity rates of 20%. 58% had an average weight, and 5% were underweight. Males, Hispanics, and B-cell ALL were associated with obesity. Obesity was associated with CNS disease. |
| Foster et al. [39] | RCS |
n = 121 Age: 2–15 years |
COG AALL0232, AALL0331, AALL0932, AALL1131, POG 9904, POG9905 | 15% of patients were overweight and 15% of patients were obese at the time of diagnosis of ALL. At 5-year follow-up, 22% of patients were overweight and 35% of patients were obese. Start of treatment BMI z-score 0.25 (95% CI 0.01–0.49) Five-year follow-up BMI z-score 0.99 (95% CI 0.79–1.19; p-value < 0.0001) |
| Didi et al. [40] | PCS |
n = 114 Age: 2–16 years |
MRC UKALL protocol | 23/51 male (45%) and 30/63 female (47%) patients were obese at final height attainment. Female patients: Girls’ obesity occurred from start to end of treatment then plateaued. Start of treatment BMI z-score 0.05 (95% CI −2.2, 2.0) End of treatment BMI z-score 1.2, 95% CI 0.3–2.8; p-value 0.0002) Male patients: Boys gained weight from the start of treatment, and weight gain continued post-treatment completion. Start of treatment BMI z -score 0.10 (95% CI −1.1, 1.3); End of treatment BMI z-score 0.6 (95% CI −0.4, 4.9; p-value 0.001) |
| Craig et al. [41] # | CSS |
n = 213 radiotherapy, n = 85 no radiotherapy Age: 0–16 years |
Unirradiated: MRC UKALL XI or infant ALL protocol Irradiated:
|
Female 18–20 Gy CRT: BMI z-score at diagnosis −0.24 ± 0.15 BMI z-score at end of treatment 0.46 ± 0.11 (p-value < 0.0001) 22–24 Gy CRT: BMI z-score at diagnosis −0.70 ± 0.16 BMI z-score at the end of treatment −0.17 ± 0.12 (p-value 0.0005) Male 18–20 Gy CRT: BMI z-score at diagnosis −0.40 ± 0.16 BMI z-score at end of treatment 0.37 ± 0.16 (p-value < 0.0001) 22–24 Gy CRT: BMI z-score at diagnosis −0.17 ± 0.28 BMI z-score at end of treatment 0.48 ± 0.16 (p-value 0.02) BMI z-scores in patients with no history of CRT: Female BMI z-score at diagnosis −0.12 ± 0.19 BMI z-score at end of treatment 0.70 ± 0.17 (p-value < 0.0001) Male BMI z-score at diagnosis 0.23 ± 0.26 BMI z-score at end of treatment 0.81 ± 0.18 (p-value 0.01) |
Abbreviations: RCR, retrospective chart review; BMI, body mass index; COG, Children’s Oncology Group; CCG, Children’s Cancer Group; BMI%, body mass index percentile; MRC, Medical Research Council; UKALL, United Kingdom Acute Lymphoblastic Leukemia Regimen; NR, not reported; CI, confidence interval; SDS, standard deviation score; NS, not significant; RCS, retrospective cohort study; CRT, cranial irradiation; OR, odds ratio; Gy, Gray; COG AALL, Children’s Oncology Group Acute Lymphoblastic Leukemia protocols; POG, Pediatrics Oncology Group; z-score, standard score; PCS prospective cohort study; CCS, cross-sectional study. # The p-values include a comparison of BMI z-scores from baseline to end of treatment. * This abstract reported a study that compared ALL patients to the National Health and Nutrition Examination Survey (NHANES) control subjects (n = 30,107). This abstract also validated the already known association of being underweight at ALL diagnosis.