Impact of body mass index on relapse in children with acute lymphoblastic leukemia treated according to Nordic treatment protocols

Egnell, Christina; Ranta, Susanna; Banerjee, Joanna; Merker, Andrea; Niinimäki, Riitta; Lund, Bendik; Mogensen, Preben; Jónsson, Òlafur G.; Vaitkevičienė, Goda; Lepik, Kristi; Forslund, Anders; Heyman, Mats; Harila‐Saari, Arja

doi:10.1111/ejh.13517

Cited by 14 publications

(17 citation statements)

References 38 publications

(93 reference statements)

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“…In our previous study, we concluded that obesity at diagnosis was associated independently with the risk of relapse in older children with ALL 4 . We hypothesised that obese older children experience more severe toxic events than healthy‐weight children and therefore their treatment may have been modified, contributing to the increased risk of relapse.…”

Section: Introductionmentioning

confidence: 98%

“…20 In our previous study, we concluded that obesity at diagnosis was associated independently with the risk of relapse in older children with ALL. 4 We hypothesised that obese older children experience more severe toxic events than healthyweight children and therefore their treatment may have been modified, contributing to the increased risk of relapse. To explore the underlying factors behind the higher relapse risk and inferior outcomes in this patient group, we studied the role of obesity in the occurrence of severe adverse events and treatment delays in children with ALL treated according to the non-high-risk arm of the NOPHO ALL2008 study.…”

Section: Introductionmentioning

confidence: 99%

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Obesity as a predictor of treatment‐related toxicity in children with acute lymphoblastic leukaemia

et al. 2021

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Summary Obesity is associated with poor outcomes in childhood acute lymphoblastic leukaemia (ALL). We explored whether severe treatment‐related toxicity and treatment delays could explain this observation. This study included 1 443 children aged 2·0–17·9 years with ALL treated with the Nordic Society of Pediatric Haematology and Oncology (NOPHO) ALL2008 non‐high‐risk protocol. Prospective treatment‐related toxicities registered every three‐month interval were used. Patients were classified according to sex‐ and age‐adjusted international childhood cut‐off values, corresponding to adult body mass index: underweight, <17 kg/m2; healthy weight, 17 to <25 kg/m2; overweight, 25 to <30 kg/m2; and obese, ≥30 kg/m2. Obese children had a higher incidence rate ratio (IRR) for severe toxic events {IRR: 1·55 [95% confidence interval (CI) 1·07–2·50]}, liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy‐weight children. Obese children aged ≥10 years had increased IRRs for asparaginase‐related toxicities compared with healthy‐weight older children: thromboses [IRR 2·87 (95% CI 1·00–8·21)] and anaphylactic reactions [IRR 7·95 (95% CI 2·15–29·37)] as well as higher risk for truncation of asparaginase [IRR 3·54 (95% CI 1·67–7·50)]. The high prevalence of toxicity and a higher risk of truncation of asparaginase may play a role in the poor prognosis of obese children aged ≥10 years with ALL.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Obesity as a predictor of treatment‐related toxicity in children with acute lymphoblastic leukaemia

et al. 2021

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“…Obesity increases the incidence and mortality of many cancers (13)(14)(15), including leukemia. In children with acute lymphoblastic leukemia (ALL), obesity increases relapse rate by ~50% (16,17) and risk of detectible minimal residual disease after the first month of chemotherapy more than two-fold (18). Tucci et al uncover a previously unidentified interaction between ALL cells and adipocytes, leading to transfer of free fatty acids for use as a metabolic fuel and macromolecule building block.…”

Section: Editorial On the Research Topic Metabolic Rewiring In Leukemiasmentioning

confidence: 99%

Editorial: Metabolic Rewiring in Leukemias

et al. 2021

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“…However, they have been poorly addressed by nutritional intervention during pediatric cancer therapy. A high BMI and obesity at diagnosis is another form of malnutrition associated with an increased risk of complications (i.e., wound infection and arterial thrombosis) [ 24 ] and, in acute lymphoblastic leukemia (ALL), of disease relapse [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Early Nutritional Intervention to Promote Healthy Eating Habits in Pediatric Oncology: A Feasibility Study

et al. 2022

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This study aims to describe the feasibility of a nutritional intervention that promotes healthy eating habits early after cancer pediatric diagnosis in patients and their parents. Participants were recruited 4 to 12 weeks after cancer diagnosis as part of the VIE study. The one-year nutritional intervention included an initial evaluation and 6 follow-up visits every 2 months with a registered dietician. The feasibility assessment included rates of retention, participation, attendance, completion of study measures, and participants’ engagement. A preliminary evaluation of the intervention's impact on the participants’ dietary intakes was conducted. A total of 62 participants were included in the study (51.6% male, mean age = 8.5 years, mean time since diagnosis = 13.2 weeks). The retention and attendance rates were 72.6% and 71.3%, respectively. Attendance to follow-up visits declined over time, from 83.9% to 48.9%. A majority of participants had high participation (50.8%) and high engagement (56.4%). Measures of body-mass-index or weight-for-length ratio and dietary 24-h recalls were the procedures with the highest completion rates. Participants with refractory disease or relapse were less likely to complete the intervention. Post-intervention, participants (n = 21) had a lower sodium intake compared to the initial evaluation. These results suggest that a nutritional intervention that involves patients and parents early after a pediatric cancer diagnosis is feasible.

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Impact of body mass index on relapse in children with acute lymphoblastic leukemia treated according to Nordic treatment protocols

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 14 publications

References 38 publications

Obesity as a predictor of treatment‐related toxicity in children with acute lymphoblastic leukaemia

Obesity as a predictor of treatment‐related toxicity in children with acute lymphoblastic leukaemia

Editorial: Metabolic Rewiring in Leukemias

Early Nutritional Intervention to Promote Healthy Eating Habits in Pediatric Oncology: A Feasibility Study

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