Obesity after Successful Treatment of Acute Lymphoblastic Leukemia in Childhood

Dongen-Melman, J. E. W. M. Van; Hokken-Koelega, Anita; Hählen, K.; Groot, A. De; Tromp, C G; Egeler, R. Maarten

doi:10.1203/00006450-199507000-00015

Cited by 125 publications

(129 citation statements)

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“…Others have suggested that anthracyclines 26,39 or dexamethasone 22,40 are associated with excess fatness after childhood ALL treated without BMT, but we could not confirm this. 25 In accordance with this, in the present study, additional cranial irradiation or GH insufficiency, but not anthracycline dose or the use of dexamethasone, were associated with excess fatness after BMT for childhood leukaemia or lymphoma.…”

Section: Discussioncontrasting

confidence: 55%

“…The previous study is limited by lack of BMI data at diagnosis of the malignancy and by analysing BMI values of children without adjusting for sex and age. 38 Several studies have suggested that persons previously treated for ALL without BMT have increased BMI, [19][20][21][22][23][24] but recently we reported that they have BMI like local controls. 25 The use of old reference values in the previous studies, random variation, and, maybe, variation in the use and dose of cranial irradiation, probably explain why our BMI findings in untransplanted ALL survivors did not agree fully with those of others.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, BMI is a less valid measure of adiposity in survivors of childhood cancer than in the background population. The BMI [19][20][21][22][23][24][25] and the degree of fatness 25-27 after childhood ALL treated without BMT have been frequently reported, but only one group has reported the BMI after childhood BMT. 28 Whereas excess fatness and, sometimes, being overweight are problems in ALL survivors treated without BMT, childhood BMT survivors seem to suffer mainly from malnutrition and being underweight, at least during the first years following transplantation.…”

Section: Discussionmentioning

confidence: 99%

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Degree of fatness after allogeneic BMT for childhood leukaemia or lymphoma

Nysom

Holm

Michaelsen

et al. 2001

Bone Marrow Transplant

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Summary:Excess fatness is frequent after childhood ALL treated without BMT. We measured the whole-body percent fat by dual-energy X-ray absorptiometry and the bodymass index (weight/height 2 (kg/m 2 ), BMI) in 25 survivors of childhood leukaemia or lymphoma (21 with ALL) who had received TBI and allogeneic BMT a median of 8 years ago (range 4-13). Adjusted for sex and age, the mean BMI was slightly but significantly reduced (0.4 s.d. below predicted) and the whole-body percent fat was significantly increased compared with healthy controls (1.1 s.d. above predicted). Eleven of 25 patients had a percent fat above the 90 percentile of the reference values, which indicates excess fatness. Adjusted for sex and age, a higher percent fat was related to additional cranial irradiation. Controlled for this, the whole-body percent fat seemed to be unrelated to age at BMT, length of follow-up, and previous chemotherapy. Compared with untransplanted ALL survivors treated with cranial irradiation, BMT survivors had significantly reduced BMI but similar whole body percent fat. BMI was a poor measure of body fatness in these patients. In conclusion, survivors of BMT for childhood leukaemia or lymphoma are adipose and slightly underweight and consequently have a substantially reduced lean body mass. Bone Marrow Transplantation (2001) 27, 817-820. Keywords: leukaemia; lymphoma; childhood; late sideeffects of therapy; body-mass index; body composition During the last decades the survival rates after childhood leukaemia and lymphoma have risen considerably. 1 For children with very high risk 2 or relapsed disease, 3-5 allogeneic BMT with a related donor will give the highest chance of survival. Unfortunately, allogeneic BMT for childhood cancer has frequent and severe delayed side-effects.Body-mass index (weight/height 2 (kg/m 2 ), BMI) is considered the best available weight-stature index in both chil- dren and adults, regarding independence of stature, correlation with body fat, and prediction of mortality. 6 Raised BMI (overweight) in childhood and adolescence increases the risk of being overweight in adulthood, 7,8 and overweight in adolescence 9 and adulthood 10,11 is associated with excess morbidity and mortality. In industrialised countries, the frequency of overweight people has increased over the last decades. 12 Whole-body dual-energy X-ray absorptiometry (DXA) is currently considered the most valid practically usable method for non-invasively measuring the body composition according to a three-compartment model based on bone mineral mass, fat mass, and non-fat non-mineral mass. 13,14 Impaired growth hormone secretion is frequent after cranial or total body irradiation for childhood cancer. 15,16 Growth hormone deficient children 17 and adults 18 are adipose, also when matched for BMI. Consequently, BMI is a less valid measure of adiposity in survivors of childhood cancer than in the background population. The BMI [19][20][21][22][23][24][25] and the degree of fatness 25-27 after childhood ALL treated without BMT have bee...

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Degree of fatness after allogeneic BMT for childhood leukaemia or lymphoma

Nysom

Holm

Michaelsen

et al. 2001

Bone Marrow Transplant

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“…In such studies, decreased 23 and normal 24,25 BMD have been reported. Moreover, contrary to the studies in which treatment included cranial irradiation, [26][27][28] no long-term side effects on lean and fat body mass were found in these studies. 23,24 However, these studies were cross-sectional, and except for 1 study, in which a limited number of patients showed a tendency to improve BMD and body composition during the first year after completion of treatment, 10 no longitudinal data on BMD, bone metabolism, and body-composition changes are avail-able for patients after completion of therapy.…”

contrasting

confidence: 41%

“…26,27 It has been postulated that the increase in body fat mass was related to multifactorial causes such as cranial irradiation (thus partly resulting from growth hormone insufficiency), to glucocorticoids (as part of treatment protocols), to increased energy intake and to the reduced energy expenditure resulting from decreased physical activity. 19,26,28,[40][41][42] Only 2 studies have investigated long-term body composition 5 to 9.6 years (mean) after completion of treatment with chemotherapy alone. A significantly higher percentage of body fat mass was found after 5 years in only a subgroup of patients who received intravenous high-dose methotrexate.…”

mentioning

confidence: 99%

Improvement in Bone Mineral Density and Body Composition in Survivors of Childhood Acute Lymphoblastic Leukemia: A 1-Year Prospective Study

Marinovic

Dorgeret²,

Lescoeur³

et al. 2005

Pediatrics

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ABSTRACT. Objectives. Abnormalities in bone mineral density (BMD), body composition, and bone metabolism have been reported in children who were treated for acute lymphoblastic leukemia (ALL) during and after completion of therapy. However, these studies are crosssectional, and no longitudinal data are available in a large group of patients after completion of therapy. In the present study, 1-year longitudinal changes in BMD, body composition, and bone metabolism were evaluated in children with ALL during the first 3 years after completion of therapy without cranial irradiation.Methods. BMD of total body (TB; g/cm 2 ), areal and apparent volumetric lumbar spine (L2-L4), lean body mass, and percentage of body fat were measured by dual-energy x-ray absorptiometry in 37 children (median age: 7.9 years; range: 4.7-20.6 years) who were treated for ALL at a median age of 3.3 years (range: 1.1-16.6 years), after a median time of 2.2 years after the completion of treatment, and after a 1-year follow-up period. Two control subjects (n ‫؍‬ 74) who were matched for gender, age, and pubertal stage were also longitudinally investigated for body composition for 1 year. Usual serum biochemical markers of calcium metabolism and bone turnover were measured in patients during the study period.Results. A slight decrease in TB BMD was found after a median time of 2.2 years after the completion of therapy for ALL in childhood. Patients showed a significantly lower median TB BMD when evaluated <1.5 years as compared with those at >1.5 years since completion of therapy. At the time of first evaluation, the percentage of body fat mass was significantly higher and patients were physically less active than their matched control subjects. Although, as expected, during the 1 year of follow-up both groups showed an annual increment in their BMD measurements, a significantly higher increase in TB BMD was observed in patients in comparison with control subjects. During this same period, the increase in the percentage of body fat mass was slightly lower in ALL patients as compared with control subjects. At the end of the follow-up year, BMD, body-composition parameters, and physical activity of ALL patients were similar to those observed in matched control subjects. Serum biochemical markers of bone turnover were normal at both evaluations.Conclusions. A significant increase in TB BMD and a tendency to a lesser increase in percentage of body fat mass were observed during the study period in ALL patients as compared with chronological age-, gender-, and pubertal stage-matched control subjects. These findings suggest a positive effect of long-term completion therapy and increase in physical activity on BMD, body composition, and bone metabolism in patients who have been treated for ALL. A cute lymphoblastic leukemia (ALL) is the most common childhood malignancy, and 80% of children with standard-risk disease can now expect to be cured. 1,2 Children with ALL have reduced bone formation 3-10 and bone mineral density (BMD) 3,9,10 at diagnosis. Seve...

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