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

Abstract

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.

Dietary intake and childhood leukemia: The Diet and Acute Lymphoblastic Leukemia Treatment (DALLT) cohort study

“…The disease process might plausibly contribute to the classification of a smaller proportion as overweight, or the geographic and ethnic distribution of our cohort may be responsible. These findings are intriguing and are the focus of ongoing analysis, particularly in the light of recent data correlating BMI percentile with mortality in children with ALL [8,10]. …”

“…The impact of obesity is not trivial. Recent meta-analyses found that the presence of obesity at diagnosis is a poor prognostic indicator in children and adults with leukemia [8–10]. In children with leukemia, those classified as obese at diagnosis have a 35% increased risk of mortality compared with those who are not obese [10].…”

“…Recent meta-analyses found that the presence of obesity at diagnosis is a poor prognostic indicator in children and adults with leukemia [8–10]. In children with leukemia, those classified as obese at diagnosis have a 35% increased risk of mortality compared with those who are not obese [10]. Importantly, several studies have suggested that remediation of either under- or overweight during therapy eliminates the adverse association with survival [11,12].…”

Overweight in childhood cancer survivors: the Swiss Childhood Cancer Survivor Study

“…The prevalence of overweight might be underestimated because having a higher BMI at diagnosis is associated with poorer survival. This could have resulted in excluding more overweight CCSs due to our exclusion criteria of ≥5 y of survival after initial diagnosis of cancer (39). Furthermore, our results could have been biased by reverse causation (e.g., a lack of sports participation could have been due to overweight).…”

Mapping and targeting of the leukemic microenvironment

“…Maintenance of osteoblast numbers during leukemia by pharmacological inhibition of the synthesis of duodenal serotonin through treatment with a tryptophan hydroxylase inhibitor stimulates normal hematopoiesis, delays disease engraftment, reduces tumor burden, and prolongs survival (Krevvata et al, 2014). Castillo et al, 2016;Castillo et al, 2012;Orgel et al, 2016;Orgel et al, 2014 Sequester and metabolize commonly used chemotherapeutic drugs Behan et al, 2009;Pramanik et al, 2013;Sheng et al, 2017Sheng et al, 2017 Secrete glutamine: inhibits the activity of L-asparaginase, a common treatment for ALL Ehsanipour et al, 2013 Fuel AML blasts survival by production of free fatty acids Shafat et al, 2017;Ye et al, 2016;Li et al, 2018Shafat et al, 2017 Lepr + Esm1 + perivascular cells…”