Prognostic Significance of Being Overweight and Obese at Diagnosis in Children With Acute Lymphoblastic Leukemia

Aldhafiri, Fahad K.; McColl, John H.; Reilly, John J.

doi:10.1097/mph.0000000000000056

Cited by 25 publications

(24 citation statements)

References 5 publications

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“…This study found that obesity was associated with a significantly increased risk of relapse, particularly in children over 10 years of age (considered high risk). This latter caveat is consistent with the findings of a relatively small study of 337 patients from the UKALL X treatment trial, which included only standard risk patients, and concluded that overweight or obesity at diagnosis was unlikely to impair prognosis (20). Thus, it appears that obesity can impair ALL outcome at least in high risk, older patients.…”

Section: Does Obesity Directly Increase Leukemia Mortality?supporting

confidence: 83%

The Role of Adipose Tissue and Obesity in Causing Treatment Resistance of Acute Lymphoblastic Leukemia

Sheng

Mittelman

2014

Front. Pediatr.

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Obesity is responsible for ~90,000 cancer deaths/year, increasing cancer incidence and impairing its treatment. Obesity has also been shown to impact hematological malignancies, through as yet unknown mechanisms. Adipocytes are present in bone marrow and the microenvironments of many types of cancer, and have been found to promote cancer cell survival. In this review, we explore several ways in which obesity might cause leukemia treatment resistance. Obese patients may be at a treatment disadvantage due to altered pharmacokinetics of chemotherapy and dosage “capping” based on ideal body weight. The adipose tissue provides fuel to cancer cells in the form of amino acids and free fatty acids. Adipocytes have been shown to cause cancer cells to resist chemotherapy-induced apoptosis. In addition, obese adipose tissue is phenotypically altered, producing a milieu of pro-inflammatory adipokines and cytokines, some of which have been linked to cancer progression. Given the prevalence of obesity, understanding its role and adipose tissue in acute lymphoblastic leukemia treatment is necessary for evaluating current treatment regimen and revealing new therapeutic targets.

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Section: Does Obesity Directly Increase Leukemia Mortality?supporting

confidence: 83%

The Role of Adipose Tissue and Obesity in Causing Treatment Resistance of Acute Lymphoblastic Leukemia

Sheng

Mittelman

2014

Front. Pediatr.

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“…Studies that showed that baseline BMI was not associated with outcome included small numbers of patients in BMI subgroups, or only analyzed the influence of being overweight on survival. [5][6][7][8]13 Studies that reported baseline undernourishment as a determinant of impaired survival were mostly conducted in developing countries or had small numbers in the BMI subgroups. [9][10][11] In those series, patients were, in addition to their disease status and treatment, also coping with additional risk factors for poor outcome such as malnutrition and poor socioeconomic risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…3 Previous studies in pediatric ALL showed contradictory results, i.e. some studies show that weight at diagnosis does not influence survival, while others suggest that being underweight or overweight at diagnosis of ALL has an influence on survival [4][5][6][7][8][9][10][11][12][13][14] (Table 1). Body composition changes extremely during the treatment of pediatric ALL due to the use of corticosteroids, 15,16 but also due to other factors such as the catabolic effect of the disease itself, stress, 17 nutritional changes and impaired exercise capacity.…”

Section: Introductionmentioning

confidence: 99%

The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia

et al. 2014

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Correspondence: m.vandenheuvel@erasmusmc.nlBody mass index and change in body mass index during treatment may influence treatment outcome of pediatric patients with acute lymphoblastic leukemia. However, previous studies in pediatric acute lymphoblastic leukemia reported contradictory results. We prospectively collected data on body composition from a cohort of newly diagnosed Dutch pediatric patients with acute lymphoblastic leukemia (n=762, age 2-17 years). Patients were treated from 1997-2004 and the median follow-up was 9 years (range, 0-10). Body mass index at diagnosis was expressed as age-and gender-matched standard deviation scores and on the basis of these scores the patients were categorized as being underweight, of normal weight or overweight. Multivariate analyses showed that patients who were underweight (8%) had a higher risk of relapse [hazard ratio: 1.88, 95% confidence interval (1.13-3.13)], but similar overall survival and event-free survival as patients who had a normal weight or who were overweight. Patients with loss of body mass index during the first 32 weeks of treatment had a similar risk of relapse and eventfree survival, but decreased overall survival [hazard ratio: 2.10, 95% confidence interval (1.14-3.87)] compared to patients without a loss of body mass index. In addition, dual X-ray absorptiometry scans were performed in a nested, single-center cohort. Data from these scans revealed that a loss of body mass consisted mainly of a loss of lean body mass, while there was a gain in the percentage of fat. In conclusion, being underweight at diagnosis is a risk factor for relapse, and a decrease in body mass index early during treatment is associated with decreased survival. In addition, loss of body mass during treatment seems to consist mainly of a loss of lean body mass. This study was approved by the Medical Ethical Committee in 1996 (trial number NTR460/SNWLK-ALL-9). The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia ABSTRACT Methods Study populationThis study included newly diagnosed pediatric ALL patients, aged 2-17 years, treated according to the Dutch Childhood Oncology Group (DCOG) -ALL9 protocol, between January 1997 and November 2004 in seven pediatric oncology centers in the Netherlands. 21 The patients were stratified at diagnosis into nonhigh-risk and high-risk treatment groups as previously described.21

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“…Partial cystectomies have only been carried out in high grade cases [33,36] and where anatomically it was reported to be difficult for adequate endoscopic resection [33].…”

Section: Discussionmentioning

confidence: 99%

“…Only one paper has reported the use of MVAC (Methotrexate, Vinblastine, Adriamycin and Cisplatin) [35]. As the rates of recurrence seem to be so low in general, this supports the current trend to hold off using adjuvant chemotherapy in this age group and avoid further invasive treatment and its side-effects [33]. However, the evidence regarding prognosis is currently too weak for any solid recommendations to be made.…”

Section: Discussionmentioning

confidence: 99%

Presentation of case: Bladder cancer in an 18 year old female patient

Sheehan¹,

Anwar²,

Kommu³

2015

International Journal of Surgery Case Reports

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IntroductionBladder cancers are not very common in the young population below 20 years of age, especially in those who have not been exposed to chemotherapy, bladder augmentation surgery and other known risk factors. By highlighting this case we hope to raise awareness in the medical community, that the symptom of visible haematuria can potentially be due to a bladder malignancy and therefore this should be thoroughly investigated.Presentation of caseAn 18-year-old female presented with intermittent macroscopic haematuria and non-specific abdominal pain. Physical examination and routine blood tests were normal. An ultrasound scan initially showed a bladder wall lesion, which a flexible cystoscopy confirmed. Histology revealed grade 2 papillary transitional cell carcinoma of the bladder with no invasion into the lamina propria (G2pTa TCCB).DiscussionWe recognise through our literature review that paediatric bladder cancers are not commonly reported in the UK. In our paper we highlight the relevant major studies that have been carried out world-wide, the reported incidence so far and gaps in the evidence base.ConclusionDespite the dearth of data about paediatric bladder malignancies there is enough case-based evidence, from world-wide sources, to support that bladder cancer must be suspected in the event of macroscopic haematuria. Ultrasound and cystoscopy are the standard diagnostic tools for bladder tumours. Endoscopic resection of the tumour followed up by interval ultrasound scans and flexible cystoscopy checks remain the mainstay of treatment hitherto.

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Prognostic Significance of Being Overweight and Obese at Diagnosis in Children With Acute Lymphoblastic Leukemia

Cited by 25 publications

References 5 publications

The Role of Adipose Tissue and Obesity in Causing Treatment Resistance of Acute Lymphoblastic Leukemia

The Role of Adipose Tissue and Obesity in Causing Treatment Resistance of Acute Lymphoblastic Leukemia

The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia

Presentation of case: Bladder cancer in an 18 year old female patient

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