Changes in body mass index during treatment of childhood acute lymphoblastic leukemia with the Nordic ALL2008 protocol

Abstract

Objectives Children with acute lymphoblastic leukemia (ALL) have a tendency to gain weight during treatment. As overweight and obesity associate with health problems, prophylactic interventions are warranted. Therefore, it is important to identify the children most prone to gain weight. Methods Patients aged 2.0–17.9 years at ALL diagnosis were identified from the NOPHO ALL2008 registry. Registry data was complemented with height and weight at the end of therapy from questionnaires. Body mass index (BMI) was classified according to international age‐ and sex‐adjusted International Obesity Task Force BMI cut‐offs. BMI values were transformed into standard deviation scores (SDS) to calculate the difference in BMISDS during treatment. Results Data on BMI change were available for 765 children. Overweight and obesity doubled during treatment: 9.7% were overweight and 2.1% obese at diagnosis and 21.8% and 5.4% at the end of therapy, respectively. The mean BMISDS change was +0.64. Younger (2.0–5.9 years) and healthy weight children were most prone to become overweight (mean change in BMI SDS +0.85 and + 0.65, respectively). Conclusions Younger children (2.0–5.9 years) with healthy weight at diagnosis were most prone to becoming overweight and therefore are an important group to target while considering interventions.

Changes in Nutritional Status during Induction Phase and Their Association with Fever and Minimal Residual Disease in Paediatric Acute Lymphoblastic Leukaemia

“…Importantly, an abnormally high BMI z -score at the end of induction was more prevalent among small children aged 0–5 years in our study compared to older patients. Similarly to our research, other studies revealed that younger children, particularly those with a healthy or lower BMI at diagnosis, were most likely to gain weight during treatment [ 28 , 29 ]. Another study performed a univariate logistic regression analysis that revealed younger age to be a risk factor for an increase in BMI standard deviation after induction chemotherapy [ 30 ].…”

Population pharmacokinetics of gentamicin in acute lymphoblastic leukemia pediatric patients compared to non-oncology patients

“…The literature presents an ongoing debate regarding differences between ALL vs. non-ALL patients in the V d and Cl of gentamicin. Given the increased body fat composition in ALL patients ( Egnell et al, 2022 ), some differences in central and peripheral V d can be anticipated when comparing ALL to non-ALL patients. Similarly, disturbances in lean body mass and renal function associated with cytotoxic medication lead to changes in serum creatinine and Cl cr ( Aapro and Launay-Vacher, 2012 , Mach et al, 2022 ), consequently affecting gentamicin clearance ( Ho et al, 1995 ).…”

Translating energy balance research from the bench to the clinic to the community: Parallel animal‐human studies in cancer

“…Weight gain can be a common side effect of therapies, especially chemotherapy, as well as hormonal therapies used for some cancers, including breast cancer, prostate cancer, and leukemia. [125][126][127] Up to 35% of cancer survivors have obesity, and obesity has been found to increase the risk of death for all cancers combined, with patients who have severe obesity experiencing a >50% increased risk of death than patients with cancer who have a healthy weight. 128 Cancer survivors may have poorer quality diets that may reflect long-term dietary patterns before diagnosis or because changes in taste and other physical and quality-of-life factors affect dietary intake postdiagnosis.…”

“…Weight‐control considerations differ between cancer survivors and individuals without cancer and may require personalized guidelines. Weight gain can be a common side effect of therapies, especially chemotherapy, as well as hormonal therapies used for some cancers, including breast cancer, prostate cancer, and leukemia 125–127 . Up to 35% of cancer survivors have obesity, and obesity has been found to increase the risk of death for all cancers combined, with patients who have severe obesity experiencing a >50% increased risk of death than patients with cancer who have a healthy weight 128 .…”