title: The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia.
abstract: Body 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 event-free 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).
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam.
authors.forename: Marissa A H
authors.initials: MA
authors.lastname: den Hoed
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam.
authors.forename: Saskia M F
authors.initials: SM
authors.lastname: Pluijm
authors.affiliation: Dutch Childhood Oncology Group, The Hague.
authors.forename: Hester A
authors.initials: HA
authors.lastname: de Groot-Kruseman
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam.
authors.forename: Mariël L
authors.initials: ML
authors.lastname: te Winkel
authors.affiliation: Dutch Childhood Oncology Group, The Hague Department of Medical Statistics and Bioinformatics, Leiden University Medical Center;
authors.forename: Martha
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Department of Pediatric Endocrinology, Erasmus MC-Sophia Children's Hospital, Rotterdam.
authors.forename: Erica L T
authors.initials: EL
authors.lastname: van den Akker
authors.affiliation: Department of Pediatric Hemato-Oncology, Nijmegen, Radboud University Medical Center Nijmegen.
authors.forename: Peter
authors.initials: P
authors.lastname: Hoogerbrugge
authors.affiliation: Academic Medical Centre, Amsterdam.
authors.forename: Henk
authors.initials: H
authors.lastname: van den Berg
authors.affiliation: Dutch Childhood Oncology Group, The Hague Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Leeuw
authors.affiliation: Dutch Childhood Oncology Group, The Hague University Medical Center Utrecht.
authors.forename: Marrie C A
authors.initials: MC
authors.lastname: Bruin
authors.affiliation: Dutch Childhood Oncology Group, The Hague Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden.
authors.forename: Dorine
authors.initials: D
authors.lastname: Bresters
authors.affiliation: Dutch Childhood Oncology Group, The Hague VU University Medical Center, Amsterdam.
authors.forename: Anjo J P
authors.initials: AJ
authors.lastname: Veerman
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Pieters
authors.affiliation: Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam Dutch Childhood Oncology Group, The Hague m.vandenheuvel@erasmusmc.nl.
authors.forename: Marry M
authors.initials: MM
authors.lastname: van den Heuvel-Eibrink
mesh_terms: D000293:Adolescent; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013851:Thinness / Q000150:complications* / Q000401:mortality*; D015431:Weight Loss