title: Obesity and outcome in pediatric acute lymphoblastic leukemia.
abstract: OBJECTIVE
  To evaluate the effect of obesity (defined as a body mass index > 95th percentile for age and sex at diagnosis) on outcome of pediatric acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  We retrospectively analyzed data from 4,260 patients with newly diagnosed ALL enrolled from 1988 to 1995 onto five concurrent Children's Cancer Group studies. Results were verified in a second cohort of 1,733 patients enrolled onto a sixth study from 1996 to 2002.
  
  
  RESULTS
  The 1988 to 1995 cohort included 343 obese and 3,971 nonobese patients. The 5-year event-free survival rate and risk of relapse in obese versus nonobese patients were 72% +/- 2.4% v 77% +/- 0.6% (P = .02) and 26 +/- 2.4 v 20 +/- 0.6 (P = .02), respectively. After adjusting for other prognostic variables, obesity's hazard ratios (HRs) of events and relapses were 1.36 (95% CI, 1.04 to 1.77; P = .021) and 1.29 (95% CI, 1.02 to 1.56; P = .04), respectively. The effect of obesity was prominent in the 1,003 patients > or = 10 years old at diagnosis; in this subset, obesity's adjusted HRs of events and relapses were 1.5 (95% CI, 1.1 to 2.1; P = .009) and 1.5 (95% CI, 1.2 to 2.1; P = .013), respectively. In a second cohort of 1,160 patients 10 years old, obesity's adjusted HRs of events and relapses were 1.42 (95% CI, 1.03 to 1.96; P = .032) and 1.65 (95% CI, 1.13 to 2.41; P = .009), respectively. The effect of obesity on outcome was unrelated to changes in chemotherapy doses, length of intervals between chemotherapy cycles, or incidence and severity of therapy-related toxicity.
  
  
  CONCLUSIONS
  Obesity at diagnosis independently predicts likelihood of relapse and cure in preteenagers and adolescents with ALL.
authors.affiliation: Childrens Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA. abutturini@chla.usc.edu
authors.forename: Anna M
authors.initials: AM
authors.lastname: Butturini
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Dorey
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Lange
authors.forename: David W
authors.initials: DW
authors.lastname: Henry
authors.forename: Paul S
authors.initials: PS
authors.lastname: Gaynon
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fu
authors.forename: Janet
authors.initials: J
authors.lastname: Franklin
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Siegel
authors.forename: Nita L
authors.initials: NL
authors.lastname: Seibel
authors.forename: Paul C
authors.initials: PC
authors.lastname: Rogers
authors.forename: Harland
authors.initials: H
authors.lastname: Sather
authors.forename: Michael
authors.initials: M
authors.lastname: Trigg
authors.forename: W Archie
authors.initials: WA
authors.lastname: Bleyer
authors.forename: William L
authors.initials: WL
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome