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

Abstract

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.

Factors of Parents-Reported Readiness for Hospital Discharge in Children with Acute Leukemia: A Cross-Sectional Study

“…Adherence to the standard chemotherapy course and timely management of the complications in the course of chemotherapy can increase the initially induced remission rate of childhood acute lymphoblastic leukemia to approximately 95%, the 5-year disease-free survival rate to approximately 80%, and the cure rate to 75%-80% [4,5]. However, various factors such as multiple hospitalizations, ongoing home care and support, patient follow-up, medical intervention, and long-term medication required during discharge a ect treatment efcacy [6,7]. Parents being the main caregivers of children play a major role in the child's treatment e cacy.…”

Hyperlipidemia in children and adolescents with acute lymphoblastic leukemia: A systematic review and meta‐analysis

“…Finally, 13 studies were included in the review (Figure 1). 8,13,14,16,17,[26][27][28][29][30][31][32][33]…”

“…Characteristics of the 13 studies are presented in Table per study; range, 34-1443), with some study populations likely to overlap as they were treated according to the same treatment protocol during the same time period (DCOG ALL-10, 27,31 St Jude Total Therapy Study XVI, 14,16 and NOPHO ALL 2008 29,32 ).…”

“…The quality assessments of the studies are described in detail in Supporting Information Table S4. Five studies were evaluated as good quality, 13,14,16,27,29 six as fair quality, 8,17,26,28,31,32 one had some concerns regarding risk of bias, 33 and one study was evaluated as poor quality. 30 More than half of the studies (7/13) were descriptive and without a comparison or control group.…”

“…30 More than half of the studies (7/13) were descriptive and without a comparison or control group. 14,17,[26][27][28][29]32 Two studies used lipid measurements from long-term survivors as a comparison group, 8,30 one study compared the lipid levels between patients with and without development of osteonecrosis, 13 whereas two studies compared hyperlipidemia between different treatment protocols. 16,31 The one randomized controlled trial investigated the effect of omega-3 fatty acids on lipid levels as compared with a placebo group.…”