<p>A Review on the Impact of Body Mass Index on Outcomes in Pediatric Leukemia</p>

Abstract

In the last decades, adults and pediatric obesity have become a major issue in developed countries. Considerable research has been conducted in patients with acute lymphoblastic (ALL) and myeloid leukemia (AML) with the aim of correlating body mass index (BMI) and outcomes in patients undergoing chemotherapy for hematological diseases. In adults, a high BMI has been associated with increased leukemia-related mortality. Whether a similar effect exists in the pediatric setting remains controversial. Some of the studies detailed in this review have reported no differences in outcomes according to BMI, whilst other reports have described higher treatment-related mortality, increased risk of relapse and death. Although the link between BMI and acute leukemia outcomes is controversial, a large number of studies describe poorer survival rates in children with AML or ALL with higher BMI. On the other hand, being underweight has been associated with higher treatment-related toxicity. Understanding more about the impact of BMI in pediatric leukemia is of utmost importance to provide prompt intervention and improve outcomes.

Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology

“…Therefore, nutritional treatment should become an integral component of medical care for pediatric patients with malignancies undergoing anticancer treatment. Proper nutrition is associated with better treatment outcomes, responses, and tolerance of chemotherapy, helps to alleviate side effects of treatment, improves the quality of life, and significantly impacts patients' physical, motor, cognitive, and neurologic development [1][2][3][4][5][6][7].…”

“…The nutritional status of children with malignancies is of crucial significance in terms of short-term consequences, such as tolerance of chemotherapy, response to chemotherapy and radiotherapy, drug metabolism, rate of treatment-related complications, and mortality and quality of life, as well as the long-term consequences-survivors' growth, motor, cognitive, and neurologic development, body composition, bone maturation, and mineral density [1][2][3][4][5][6][7]. With an understanding of this, nutritional support should be an integral component of complex anticancer management.…”

The role of nutrition in children with cancer

“…39 Nutritional Assessment: Furthermore, a link between obesity and higher rates of fatal infection and more treatment-related mortality has been suggested. 44,45…”

“…Similar considerations were reported by Triarico et al, 46 who concluded that a personalized evaluation of nutritional risk at diagnosis and close monitoring of nutritional status are crucial for ensuring a timely and personalized nutritional intervention, which may potentially improve tolerance to chemotherapy and survival, in turn preventing prolonged hospitalization for infections. In a recent review, Paviglianiti 45 underscored how being at either extreme of the index (underweight or obese) is associated with worse outcomes and toxicities in children with leukemia or undergoing hematopoietic stem-cell transplantation (HSCT).…”

Estado nutricional y supervivencia de los pacientes con leucemia linfoblástica aguda atendidos en el Instituto Nacional de Enfermedades Neoplásicas, 2017-2019

“…Existen estudios que abordan el impacto de la obesidad en los resultados de pacientes pediátricos con LLA, sin embargo en población adulta son escasos 29 . Por lo que comprender el impacto pronóstico del IMC no solo tendría implicaciones clínicas en los pacientes con LLA, sino también en la de salud pública con intervención preventiva que podría mejorar sus resultados 42 . Asimismo, determinar la relación entre el estado nutricional y LLA podría generar mejoras significativas en la supervivencia de dichos pacientes 43 .…”