Trends in body mass index (BMI) during and after treatment for standard risk (SR) acute lymphoblastic leukemia (ALL): A report from the Children’s Oncology Group (COG).

Abstract

9546 Background: Obesity is a potential complication in children treated for ALL. Limited data exist regarding timing of BMI changes and risk in long-term survivors of ALL treated without cranial radiation (CRT). This study describes temporal trends in BMI during and after therapy for SR-ALL and identifies associated factors. Methods: We conducted a retrospective cohort study of children with SR-ALL enrolled on two sequential clinical trials between 1993 and 2000 and on the COG ALTE02C2 follow-up study. Therapy included prednisone or dexamethasone during induction, the same steroid in maintenance phases, and no CRT. Standing height and weight was ascertained at diagnosis (dx), start of consolidation, start of maintenance, start of the last cycle of maintenance, and at least one year off therapy. Age and gender-specific BMI percentiles (BMI%) were calculated using 2000 CDC growth charts for patients 2-20 years. Results: The 269 subjects were a median of 3.5 years at dx, 46.7% female, 82.3% white, and a median of 9.1 years since dx at the last timepoint. The BMI% was associated with elapsed time since dx: BMI% increased between dx and consolidation (50.9%-68.3%, p < 0.0001), remained stably elevated until the end of maintenance, and then decreased somewhat from the end of maintenance to the last timepoint (74.1%-70.6%, p = 0.03). After therapy, 18.1% of survivors were overweight (BMI% 85-95) and 20.9% were obese (BMI% ≥ 95). By unadjusted linear regression, higher dx BMI% was positively associated with BMI% post-therapy (p < 0.0001). There was an interaction with steroid and dx BMI% such that the association between dx BMI% and post therapy BMI% was significantly greater for the dexamethasone group than the prednisone group (p = 0.01). There was no association with age at dx, gender, or race. Conclusions: In this retrospective study of SR-ALL survivors treated without CRT, we found that BMI% increased significantly in the month after dx and remained substantially elevated even several years after the end of therapy. Dx BMI% was highly associated with off-therapy BMI%, particularly in patients who had received dexamethasone rather than prednisone.