Effect of body mass index on the outcome of children with acute myeloid leukemia

Abstract

BACKGROUND The effect of body mass index (BMI) on treatment outcome of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS Children with AML (n=314) enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥ 85th percentile). RESULTS Twenty-five (8.0%) patients were underweight, 86 (27.4%) overweight/obese, and 203 (64.6%) had healthy weight. Five-year overall survival of overweight/obese patients (46.5±7.3%) was lower than that of patients with healthy weight (67.1±4.3%, P < .001); underweight patients also tended to have lower survival rates (50.6±10.7%, P = .18). In a multivariable analysis adjusting for age, leukocyte count, FAB type, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P = .01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P = .03). There was no difference in the occurrence of induction failure or relapse among BMI groups but underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially due to infection (P = .009). CONCLUSIONS An unhealthy BMI is associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care, with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics-guided chemotherapy dosing may improve outcome.

Effect of age and body weight on toxicity and survival in pediatric acute myeloid leukemia: results from NOPHO-AML 2004

“…This speculation is in part contrasted by Hijiya et al 39 who have shown that in pediatric ALL, there is no statistical difference in pharmacokinetics of cytarabine between normal and overweight patients. Previous studies have found increased TRM in overweight 12 and obese 13 patients with AML resulting in poorer outcome for this group; in this cohort, however, none of 9 TRM cases in children over one year of age were overweight. In contrast, we surprisingly found a trend for being overweight at diagnosis being associated with superior outcome in children aged 10-17 years [unrelated to t(8;21) status], similar to what has been reported in adults with AML.…”

“…To our knowledge, no previous studies have reported such a thorough review of toxicities and associations with age and body weight at diagnosis, though many studies suggest similar associations. 12,13,18,19,26,27 We found a trend for age 10-17 years being associated with poorer survival. In contrast to previous studies, 12,13 we found a trend for being overweight being associated with improved survival in children aged 10-17 years.…”

“…In our cohort, few were obese (n=16, 29% of the overweight group) compared to all and 57% of the patients in the overweight group in two American studies. 12,13 This difference might partly explain the difference in results.…”

“…As a sensitivity analysis, we performed the survival analysis using the 2000 Center for Disease Control (CDC) Growth charts 25 to investigate if differences in results between our and previous studies 12,13 could be explained by difference in growth standard. Sixteen children were reclassified (11 overweight as healthy weight and 5 healthy weight as underweight) using this approach, but the tendency for overweight children aged 10-17 years to have a better outcome remained (5-year EFS 57% vs. 43%, adjusted HR 0.6 95%CI: 0.3-1.2 and 5-year OS 77% vs. 58%, adjusted HR 0.5 95%CI: 0.2-1.2).…”

The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia

“…This has also been shown in pediatric acute myeloid leukemia. 42,43 This U-shaped association seems logical as both weight status and weight change affect and/or can be affected by disease severity. Overweight patients may have a compromised outcome as a result of a deficient immune response due to higher levels of sex steroids, insulin, insulin-like growth factor and inflammatory parameters and have an increased risk of comorbidities related to their excess weight.…”