Longitudinal Changes in Obesity and Body Mass Index Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report From the Childhood Cancer Survivor Study (original) (raw)
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Medical and Pediatric Oncology, 2000
Background. The risk factors responsible for an increased prevalence of obesity or overweight in survivors of acute lymphoblastic leukemia (ALL) remain controversial. We evaluated changes in body mass index (BMI) in a cohort of ALL survivors, all of whom have been followed until completion of linear growth. Procedure. BMI (weight/height 2) was used as an index of adiposity and was calculated at diagnosis, at the end of treatment, and at attainment of final height in a cohort of 126 (59 males) survivors of ALL. BMI was adjusted for age and sex by computing a BMI standard deviation score (SDS) or z score. The spectrum of therapies used included intrathecal chemotherapy given alone (n = 38) or combined with cranial irradiation (CRT; 18 Gy, n = 35; 24 Gy, n = 53) and exposure to prednisone at a low dose (<3.5 gm, n = 49), medium dose (3.5-9.4 gm, n = 46), or high dose (>9.4 gm, n = 30). Results. Overall, mean ± SEM BMI-SDS increased significantly between diagnosis (−0.18 &plminus; 0.08) and the end of therapy (0.41 ± 0.09, P < 0.01), with no significant change thereafter. For patients without CRT, mean BMI-SDS remained unchanged, whereas, for those so treated, mean BMI-SDS increased significantly between diagnosis and the completion of therapy (P < 0.001). The change in mean BMI-SDS was greater in the 24 Gy group vs. the 18 Gy CRT sample (P < 0.005). In a multivariate logistic regression model, CRT was an independent predictor of being overweight (BMI Ն85 percentile) at attainment of final height [odds ratio = 1.6 (95% confidence interval 1.0-23.1)]. The percentage of subjects who were overweight at attainment of final height was 10.5%, 40%, and 38% for subjects treated with no CRT, 18 Gy CRT, or 24 Gy CRT, respectively (P < 0.01). Conclusions. Children with ALL given CRT develop increases in their BMI-SDS early on and during treatment and remain at significant risk for becoming overweight as young adults, a development that may increase their already heightened risk for various adverse health outcomes. Med. Pediatr. Oncol. 35:91-95, 2000.
Pediatric Blood & Cancer, 2009
BackgroundThis retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961.This retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961.ProcedurePatients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 × ln(BMI/median BMI).Patients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 × ln(BMI/median BMI).ResultsBy the end of treatment, 23% of children were obese (BMI ≥95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5–9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity.By the end of treatment, 23% of children were obese (BMI ≥95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5–9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity.ConclusionsSuccessful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5–9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction. Pediatr Blood Cancer 2009; 53:1249–1254. © 2009 Wiley-Liss, Inc.Successful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5–9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction. Pediatr Blood Cancer 2009; 53:1249–1254. © 2009 Wiley-Liss, Inc.
A cross-sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL)
Pediatric Blood & Cancer, 2011
Over the past 25 years, the prevalence of overweight in children and adolescents has doubled and obesity has tripled such that childhood overweight is now considered a public health crisis . This population of overweight children and adolescents is at increased risk for morbidity and mortality from chronic health diseases including diabetes, coronary artery disease, and other overweight-related illnesses during adulthood . Overweight has also been associated with an increased risk for the development of cancer during adulthood, and overweight adults with cancer have inferior survival outcomes .
International Journal of Pediatrics, 2015
Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols ( = 80) to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI -scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% ( < 0.004) for females but remained relatively unchanged for males (9.8% to 13.7%, = 0.7). Longitudinal analysis using linear mixed-effects identified associations between BMI -scores and time-dependent interactions with sex ( = 0.0005), disease risk ( < 0.0001), age ( = 0.0001), and BMI -score ( < 0.0001) at diagnosis and total dose of steroid during maintenance ( = 0.01). Predicted mean BMI -scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL.
Obesity in Pediatric ALL Survivors: A Meta-Analysis
PEDIATRICS, 2014
Obesity in Pediatric ALL Survivors: A Meta-Analysis abstract BACKGROUND AND OBJECTIVE: Previous studies of survivors of pediatric acute lymphoblastic leukemia (ALL) have drawn heterogeneous conclusions regarding the prevalence of obesity and risk factors for developing obesity in pediatric ALL survivors. We sought to determine the prevalence of obesity in pediatric ALL survivors and examine risk factors for obesity through a systematic review and meta-analysis.
Cancer, 2018
Children with acute lymphoblastic leukemia (ALL) have an increased risk of obesity and short stature. To the authors' knowledge, data regarding patients treated on contemporary protocols without cranial irradiation are limited. Changes in z scores for body mass index (BMI), height, and weight from the time of diagnosis to 5 years off therapy were evaluated using multivariable analysis in 372 children with ALL who were aged 2 to 18 years at the time of diagnosis and were enrolled on the St. Jude Children's Research Hospital Total XV protocol from 2000 through 2007. The percentage of overweight/obese patients increased from 25.5% at the time of diagnosis to approximately 50% during the off-therapy period. Median BMI z scores increased significantly during glucocorticoid therapy (induction: ∆0.56; 95% confidence interval [95% CI], 0.29-0.64 [P<.001]; and reinduction II: ∆0.22; 95% CI, 0.13-0.49 [P=.001]) and during the first year after therapy (∆0.18; 95% CI, 0.08-0.46 [P=.0...