Survivors of standard risk acute lymphoblastic leukemia do not have increased risk for overweight and obesity compared to non‐cancer peers: A report from the Children's Oncology Group

Abstract

Background We sought to determine whether survivors of standard risk ALL (SR-ALL) treated without cranial radiation have increased risk for obesity by assessing changes in body mass index (BMI) during and after treatment; identifying contributing patient and treatment factors; comparing rates of overweight/obese to national health data. Procedure Eligibility for this retrospective cohort study included 1) previous enrollment on legacy therapy trials CCG1922 or CCG1952; 2) continuous first remission; and 3) age at follow-up evaluation of 6-16.99 years. Height and weight from diagnosis, consolidation, start of maintenance, last cycle of maintenance, and off-therapy were analyzed. Results The 269 subjects were a median age of 3.5 years at diagnosis and 13.3 years at follow-up. BMI% significantly increased from induction to consolidation (+17.6 ± 1.6%), start of maintenance to end-of-treatment (+3.3 ± 1.6%) and decreased from end-of-treatment to follow-up (−3.5 ± 1.6%,). Higher BMI% at follow-up was associated with higher BMI% at diagnosis (p < 0.0001), but not age at diagnosis, gender, or race. Patients previously randomized to dexamethasone had a stronger association between BMI% at diagnosis and BMI% at follow-up than those who received prednisone (p=0.0005). At follow-up, 39% of survivors were overweight or obese; the relative risk of overweight/obese was 1.028 (p=0.738) compared to the general population. Conclusions Our study of patients with SR-ALL found a significant increase in BMI% largely during the first month of therapy that is greater with dexamethasone than prednisone. However, after therapy, there was no increased risk of overweight/obese BMI compared to non-cancer peers.

Changes in body mass index in long-term survivors of childhood acute lymphoblastic leukemia treated without cranial radiation and with reduced glucocorticoid therapy

“…Compared with diagnosis, children's BMI z‐score remained significantly higher at the end of the glucocorticoid‐free maintenance phase, which marked the end of treatment and at 5 and 7 years after diagnosis. These findings extend upon previous studies by demonstrating long‐term increases in BMI z‐score, a commonly used and well‐validated measure of adiposity, in children with ALL treated without cranial radiation and with a glucocorticoid‐free maintenance phase.…”

“…Given these factors and its increased potency for stimulating weight gain, it is plausible that dexamethasone may have a greater obesogenic effect compared with prednisone, as our data would suggest. However, the evidence regarding its long‐term effect on body composition is contradictory . Some studies have found evidence that dexamethasone stimulates greater short‐term increases in standardized measures of BMI than prednisone during and after ALL treatment, as well acute activation of metabolic syndrome components such as insulin resistance, hypertension, and dyslipidemia, while other studies have not …”

High‐intensity resistance training attenuates dexamethasone‐induced muscle atrophy

“…BW loss is a widely reported phenomenon during acute or short‐term glucocorticoid treatment in animals, especially in rodents and at high doses . However, it is worth mentioning that, in humans on long‐term glucocorticoid therapy, BW gain is commonly observed, and this response may be explained by the action of DEX on the BW set‐point, which may be determined by the dose of glucocorticoids and hypothalamic corticotrophin‐releasing hormone concentrations …”

Psychosocial determinants of physical activity and dietary behaviors in adolescents and young adults with cancer and survivors

“…With an increasing appreciation of the need to start lifestyle interventions early on in therapy for pediatric malignancies, the transtheoretical model may serve as a guide in their development. The well‐established importance of targeting psychosocial variables (SOC and self‐efficacy) during lifestyle counseling highlights the need to enhance our understanding of how psychosocial variables are related to one another and how they may fluctuate throughout the spectrum of cancer care . Inclusion of this knowledge in the design of lifestyle interventions is more likely to lead to sustained behavioral change.…”