L‐asparaginase as a marker of chemotherapy dose modification in children with acute lymphoblastic leukemia

Abstract

BACKGROUND The objective of the current study was to compare chemotherapy dose modifications in obese (a body mass index [BMI] > 95%) and nonobese (a BMI ≤ 95%) pediatric patients with acute lymphoblastic leukemia (ALL). METHODS The study cohort was comprised of 199 pediatric patients diagnosed with ALL who were treated at 1 of 2 South Texas pediatric oncology centers between 1990–2000. The relative chemotherapy dose modification during the induction phase of chemotherapy was calculated as the ratio of 1) the actual administered dose of L‐asparaginase and 2) the protocol‐calculated dose of L‐asparaginase. The extent to which the chemotherapy dose modification varied according to obesity status was assessed using stratified Student t tests and an ordinary least‐squares regression analysis. RESULTS Obese ALL patients were found to exhibit a 7% decrease in the mean relative modification of L‐asparaginase during induction chemotherapy compared with their nonobese counterparts. This finding was statistically significant (P = 0.009), even after adjustment for gender, age, ethnicity, and clinical institution. CONCLUSIONS To the authors' knowledge, the current study is the first published report of an obesity‐associated chemotherapy dose modification in pediatric patients with ALL, the most common childhood malignancy. It will be important to examine whether these findings are consistent with those observed in future studies, and ultimately to assess the association between obesity‐related dose modifications and long‐term cancer outcomes. Cancer 2005. © 2005 American Cancer Society.

Pediatric Dosing and Body Size in Biotherapeutics

“…The study concluded that normalization of dose based on body surface area was appropriate in the pediatric patients studied. A statistical analysis using linear regression was performed to compare chemotherapy dose modifications in obese and non-obese pediatric patients with acute lymphoblastic leukemia (ALL) [117]. Obese ALL children were reported to have a 7% decrease in the mean relative modification of L-asparaginase compared with non-obese children.…”

Obesitas Sebagai Faktor Prognosis Buruk pada Anak dengan Leukemia Limfoblastik Akut

“…5 Perbedaan dosis lebih besar pada pasien usia 10-18 tahun dibandingkan di bawah 10 tahun; hal ini mungkin disebabkan oleh tingginya IMT, sehingga diperlukan dosis yang lebih besar. 5,20 Obesitas dapat meningkatkan risiko terjadinya LLA terkait beberapa mekanisme, yaitu melalui peningkatan hormon endogen seperti hormon seks steroid, insulin, dan insulin growth factor-1. 5 Hal ini disebabkan oleh penumpukan lemak tubuh yang berperan dalam mengontrol pertumbuhan, diferensiasi dan metabolisme sel.…”

Prognosis Leukemia Limfoblastik Akut pada Anak Obes

“…Hal ini mungkin disebabkan oleh tingginya IMT pada anak usia 10-18 tahun sehingga modifikasi dosis menjadi lebih besar. 7 Obesitas meningkatkan risiko untuk menderita kanker. Beberapa mekanisme yang dianggap berperan adalah meningkatnya hormon endogen (hormon sex steroids, insulin dan insulin growth fasctore-1) karena adanya akumulasi lemak tubuh yang berperan penting dalam mengontrol pertumbuhan, diferensiasi dan metabolisme sel.…”