Longitudinal Changes in Obesity and Body Mass Index Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report From the Childhood Cancer Survivor Study

Abstract

A B S T R A C T PurposeWe examined the rate of increase in the body mass index (BMI; kg/m 2 ) after final height attainment in survivors of acute lymphoblastic leukemia (ALL) and a noncancer comparison group. MethodsChildhood Cancer Survivor Study (CCSS) is a retrospectively ascertained cohort study that prospectively tracks the health status of adults who were diagnosed with childhood cancer between 1970 and 1986 and a comparison group of siblings. Changes in BMI from baseline enrollment to time of completion of follow-up (mean interval, 7.8 years) were calculated for 1,451 ALL survivors (mean age, 32.3 years at follow-up) and 2,167 siblings of childhood cancer survivors (mean age, 35.9 years). ResultsThe mean BMI of the CCSS sibling comparison group increased with age (women, 0.25 units/yr, 95% CI, 0.22 to 0.28 units; men, 0.23 units/yr, 95% CI, 0.20 to 0.25 units). Compared with CCSS siblings, ALL survivors who were treated with cranial radiation therapy (CRT) had a significantly greater increase in BMI (women, 0.41 units/yr, 95% CI, 0.37 to 0.45 units; men, 0.29 units/yr; 95% CI, 0.26 to 0.32 units). The rate of BMI increase was not significantly increased for ALL survivors who were treated with chemotherapy alone. Younger age at CRT exposure significantly modified risk. ConclusionCRT used in the treatment of childhood ALL is associated with a greater rate of increasing BMI, particularly among women treated with CRT during the first decade of life. Health care professionals should be aware of this risk and interventions to reduce or manage weight gain are essential in this high-risk population.

Metabolic syndrome in adults who received hematopoietic stem cell transplantation for acute childhood leukemia: an LEA study

“…This higher risk is all the more remarkable because, in the general population, men are usually more prone to abdominal obesity than women. Such a sensitivity has been shown previously: [46][47][48] women who received cranial irradiation were more likely to develop obesity. Women from our cohort were also more likely to have lower HDL cholesterol.…”

Energy balance and fitness in adult survivors of childhood acute lymphoblastic leukemia

“…were somewhat lower than in our study (survivors 27.3 6 6.9, comparison group 27.5 6 6.9 kg/m 2 ), potentially because CCSS participants self-reported height and weight. 4 This should be good news for female ALL survivors not exposed to CRT. However, both our study and data from CCSS indicate that half of ALL survivors not exposed to CRT are overweight or obese, increasing their risk for other chronic health conditions, such as diabetes, 33 heart disease, 34 and some types of cancer.…”

“…By the age of 50 years, it is estimated that over 40% of ALL survivors will have at least 1 severe, disabling, or life-threatening chronic condition. 3 Risk for adverse energy balance, including obesity, 4 poor fitness, 5 suboptimal dietary intake, 6,7 and physical inactivity, 3 are increased in ALL survivors when compared with peers. This is likely both the result of and a contributor to poor health status.…”

DIAGNOSIS OF ENDOCRINE DISEASE: Endocrine late-effects of childhood cancer and its treatments

“…Obesity also affects a substantial proportion of ALL survivors with a prevalence of 34-46% at 10 years of follow-up (184). Although cranial irradiation represents a significant risk factor of obesity and diabetes mellitus in ALL survivors (185), those treated with chemotherapy alone continue to experience high rates of persistent obesity and overweight after many years of follow-up, likely because of their prolonged exposure to high-dose glucocorticoids (186). Patients treated with HSCT do not seem to experience higher rates of obesity than similar aged individuals from the general population, but they were reported to have increased risks of insulin resistance, glucose intolerance and abnormal body composition (187).…”