Therapy‐related changes in body size in Hispanic children with acute lymphoblastic leukemia

Abstract

BACKGROUND The objective of this study was to examine changes over time in body mass index (BMI) from diagnosis through chemotherapy for pediatric patients with B‐precursor acute lymphoblastic leukemia (ALL). METHODS The study cohort consisted of 141 white Hispanic pediatric patients who were diagnosed with ALL and were treated at 2 South Texas pediatric oncology centers between 1993 and 2002. Changes in age‐standardized and gender‐standardized BMI scores were assessed. RESULTS The study cohort exhibited a steady increase in age‐adjusted and gender‐adjusted BMI scores for the first 12 months of therapy, a modest increase in BMI scores during the 18–23 month and 24–29 month periods, followed by a slight decrease in BMI scores at 30 months (end of therapy). A repeated‐measures analysis indicated significant effects for time (P = 0.019) and time by baseline BMI category interaction (P = 0.0001) but no significant interaction effect between time and gender (P = 0.65). CONCLUSIONS Although it is known that leukemia therapy is associated with prevalent obesity in survivorship, its pattern of development during therapy has not been elucidated. In the current cohort of Hispanic children with ALL, BMI scores were elevated at diagnosis (mean ± standard deviation standardized BMI Z score, 0.33 ± 1.4), then increased, and remained elevated for the entire duration of chemotherapy. Patients who were classified as normal weight exhibited an increase in BMI over time; patients who were classified as overweight at diagnosis exhibited BMI patterns that were relatively stable; and patients who were classified as obese exhibited a very slight decline over time. These findings suggest that the risk for chemotherapy‐related weight gain applies predominantly to children who begin ALL therapy within a normal weight range. Cancer 2005. © 2005 American Cancer Society.

Obesity and hypertension among children after treatment for acute lymphoblastic leukemia

“…The risk of an increased BMI compared with population controls has been previously reported among survivors of childhood ALL,6–19 with most studies examining patients treated before 1990, when cranial radiotherapy combined with less intensive chemotherapy regimens were used more commonly. Cranial radiotherapy >20 Gy was a commonly identified risk factor for increased BMI among patients in these studies 8, 10, 12, 13.…”

“…However, because these associations have been identified primarily among patients treated before 1990, they may not be applicable to more contemporary regimens that utilize less cranial radiotherapy but more intensive chemotherapy, including more potent corticosteroids 1. Studies that examined patients treated in the contemporary era have reported increased obesity even in the absence of radiotherapy,18, 19 but to our knowledge have not identified which elements of chemotherapy may be responsible, nor have they examined blood pressure changes.…”

Characteristics and Determinants of Adiposity in Pediatric Cancer Survivors

“…Adiposity in survivors of childhood leukemia (8,9,23–27) and brain tumors (28, 29) has been studied. The prevalence of overweight and obesity, as measured by BMI, in childhood acute lymphoblastic leukemia survivors ranges between 21% and 54% (overweight) and 14% and 30% (obese) in some studies.…”

Obesity in patients with acute lymphoblastic leukemia in childhood

“…For the ones overweight at diagnosis, BMI exhibited no consistent pattern of increase or decrease over time. For the obese sub cohort, there was described a slight overall decrease over time [10]. Gender-dependent differences in weight gain pattern have been already reported [11].…”