Body Mass Index at Pediatric Leukemia Diagnosis and the Risks of Relapse and Mortality: Findings from a Single Institution and Meta-analysis

Abstract

High body mass index (BMI) is associated with relapse of certain adult cancers, but limited knowledge exists on its association with pediatric leukemia relapse. We evaluated the association between overweight/obesity (BMI ≥ 85th percentile) at pediatric leukemia diagnosis and relapse or mortality. A meta-analysis combining our findings with those of previous studies was also performed. The study included 181 pediatric leukemia patients. Sporadic missing data were multiply imputed, and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazard. Age- and sex-adjusted analysis for patients ≥10 years showed a trend towards increased risk of relapse for overweight/obese patients (HR = 2.89, 95% CI = 0.89–9.36, p=0.08) that was not evident among children<10 years (HR = 0.52, 95% CI = 0.08–3.54, p=0.49). We observed a statistically significant association between mortality and obesity status in unadjusted models (imputed: HR = 2.54, 95% CI = 1.15–5.60, p=0.021; complete set: HR = 2.72, 95% CI = 1.26–5.91, p=0.011) that was not statistically significant in both age- and sex-adjusted and multivariable adjusted analyses. The pooled estimate of our finding and previous studies showed an association between overweight/obese and increased risk of mortality for ALL (HR = 1.39, 95% CI = 1.16–1.46) and AML (HR = 1.64, 95% CI = 1.32–2.04). Although our study did not observe statistically significant associations due to a small sample size, the meta-analyses revealed an increased risk of mortality for overweight/obese patients. The findings of our study suggest an association of obesity status with relapse in children ≥10 years. However, our study was based on a small sample size from a single institution, and this association needs to be investigated in larger, multicenter studies.

Is There a Causal Relationship between Childhood Obesity and Acute Lymphoblastic Leukemia? A Review

“…Obesity may impact treatment outcomes in ALL. Overweight and obese children have worse event-free survival and a higher rate of morbidities than non-obese children during the induction phase [ 57 , 58 , 59 , 60 ]. Furthermore, obesity during the premaintenance chemotherapy phase is a risk factor for hypertension (OR 3.27; 95% CI 1.10–10.00; p = 0.05), hyperglycemia (OR 2.62; 95% CI 1.04–6.56; p = 0.04), and febrile neutropenia (incident rate ratio 1.53; 95% CI 1.10–2.12; p = 0.01) [ 60 ].…”

Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors

“…Concerning ALL overweight/obese patients, the meta-analysis revealed an increased mortality and relapse risk (HR = 1.79, 95% CI = 1.03-3.10) and (HR = 1.28, 95% CI = 1.04-1.57) respectively. Similarly, an association between obesity and increased risk of mortality was observed for AML patients (HR = 1.64, 95% CI = 1.32-2.04) [63].…”

“…In the recent retrospective analysis, Saenz et al [63] evaluated the association between overweight/obesity (BMI ≥ 85th percentile) at pediatric leukemia diagnosis and relapse or mortality. The study included 181 pediatric patients diagnosed with ALL, AML, and chronic myeloid leukemia (CML).…”

Health-Promoting Lifestyle and Its Predictors in Adolescent Survivors of Childhood Cancer

“…The prevalence of obesity was higher than average for both survivors and siblings, although the survivors had higher obesity rates than their siblings (13.5% vs. 7.5%). Previous research has demonstrated that being overweight and obese is related to an increased risk of cancer recurrence and mortality for pediatric cancer survivors older than 10 years (Saenz et al, 2018). Hence, weight management via targeted counseling for physical activity and diet needs to be initiated as early as possible.…”