The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia

H M Eissa,D Campana,E K Browne,M V Relling,J C Panetta,H Inaba,C-H Pui,S Jeha,Y Zhou,C Cheng

doi:10.1038/bcj.2017.11

Abstract

The impact of body mass index (BMI) at diagnosis on treatment outcome in children with acute lymphoblastic leukemia (ALL) is controversial. We studied 373 children with ALL enrolled on the Total XV study, which prospectively used minimal residual disease (MRD) for risk assignment. MRD on day 19 and at the end of remission induction (day 46), cumulative incidence of relapse/refractory disease (CIR), event-free survival (EFS) and overall survival (OS) were evaluated using sets of four, three and two subgroups based on BMI at diagnosis, along with BMI percentile change during remission induction. Higher BMI was associated with older age and higher treatment risk. There was no association between MRD on days 19 or 46 and BMI for four, three or two BMI subgroups (P>0.1 in all cases), nor was BMI associated with CIR or EFS. Obese patients had worse OS compared with non-obese (P=0.031) due to treatment-related mortality and less salvage after refractory disease or bone marrow relapse. No association between BMI change during remission induction and MRD, CIR, EFS or OS was seen. BMI at diagnosis does not predict poorer response or relapse in a contemporary MRD-directed ALL regimen. Improvements in supportive care and innovative, less-toxic frontline/salvage therapies are needed, especially for obese patients.

Highlights

Higher body mass index (BMI) was associated with older age at diagnosis (P = 0.008) and higher Total XV risk (P = 0.041; Table 1)
Death and toxicities in obese and non-obese patients As obese patients had worse overall survival (OS) when compared with non-obese patients, we evaluated the details of the 55 events and 30 deaths
We evaluated the association between BMI at diagnosis, early treatment response as assessed by minimal residual disease (MRD) and longterm outcome in children with acute lymphoblastic leukemia (ALL)

Summary

INTRODUCTION

The 5-year survival rate for acute lymphoblastic leukemia (ALL), the most common childhood cancer, has risen over the past 4 decades to exceed 90%.1–3 This is the result of improved risk-directed protocol treatment and supportive care.[2]. The 5-year survival rate for acute lymphoblastic leukemia (ALL), the most common childhood cancer, has risen over the past 4 decades to exceed 90%.1–3 This is the result of improved risk-directed protocol treatment and supportive care.[2]. Treatment The Total XV protocol has been described elsewhere.[12] Risk classification was based on the presenting characteristics (age, white blood cell count, immunophenotype and cytogenetics) and treatment response as measured by MRD level during remission induction (on day 19) and at the end. Common Terminology Criteria for Adverse Events (CTCAE) version 3.0

Statistical methods

RESULTS

DISCUSSION