Weight patterns in children with higher risk ALL: A report from the Children's Oncology Group (COG) for CCG 1961.
BACKGROUND
This retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961.


METHODS
Patients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 x ln(BMI/median BMI).


RESULTS
By the end of treatment, 23% of children were obese (BMI >or=95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5-9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity.


CONCLUSIONS
Successful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5-9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction.
Withycombe
Janice S
JS
Children's Cancer and Blood Disorder Center, South Carolina Cancer Center, Columbia, South Carolina, USA.
Post-White
Janice E
JE
Meza
Jane L
JL
Hawks
Ria G
RG
Smith
Lynette M
LM
Sacks
Nancy
N
Seibel
Nita L
NL
D000293:Adolescent; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D003561:Cytarabine / Q000008:administration & dosage / Q000009:adverse effects; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005006:Ethnicity; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D018149:Glucose Intolerance / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009765:Obesity / Q000453:epidemiology / Q000209:etiology; D010195:Pancreatitis / Q000139:chemically induced / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012306:Risk; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D015430:Weight Gain; D015431:Weight Loss; D055815:Young Adult
D003561:Cytarabine; D014750:Vincristine; D001215:Asparaginase; D011241:Prednisone; D008727:Methotrexate; D003630:Daunorubicin
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