title: Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia.
abstract: Obesity is associated with poorer event-free survival (EFS) in pediatric acute lymphoblastic leukemia (ALL). Persistent minimal residual disease (MRD) in the bone marrow as measured by multidimensional flow cytometry (MDF) is a key early prognostic indicator and is strongly associated with EFS. We therefore hypothesized that obesity during induction would be associated with positive end-of-induction MRD (≥0.01%). We analyzed MDF of end-induction bone marrow samples from a historical cohort of 198 children newly diagnosed with B-precursor ALL (BP-ALL) and treated with Children's Oncology Group induction regimens. We assessed the influence of body mass index on risk for positive end-induction MRD in the bone marrow. In our cohort of BP-ALL, 30 children (15.2%) were overweight and 41 (20.7%) were obese at diagnosis. Independent of established predictors of treatment response, obesity during induction was associated with significantly greater risk for persistent MRD (odds ratio, 2.57; 95% confidence interval, 1.19 to 5.54; P = .016). Obesity and overweight were associated with poorer EFS irrespective of end-induction MRD (P = .012). Obese children with newly diagnosed BP-ALL are at increased risk for positive end-induction MRD and poorer EFS.
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, CA; University of Southern California, Los Angeles, CA;
authors.forename: Etan
authors.identifier: http://orcid.org/0000-0002-1487-6818
authors.initials: E
authors.lastname: Orgel
authors.affiliation: Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA; and.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tucci
authors.affiliation: Childrens Specialty Centers of Nevada, Las Vegas, NV.
authors.forename: Waseem
authors.initials: W
authors.lastname: Alhushki
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA;
authors.forename: Jemily
authors.initials: J
authors.lastname: Malvar
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California, Los Angeles, CA;
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California, Los Angeles, CA;
authors.forename: Cecilia H
authors.initials: CH
authors.lastname: Fu
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California, Los Angeles, CA;
authors.forename: David R
authors.initials: DR
authors.lastname: Freyer
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California, Los Angeles, CA;
authors.forename: Hisham
authors.initials: H
authors.lastname: Abdel-Azim
authors.affiliation: Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; University of Southern California, Los Angeles, CA; Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA; and.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Mittelman
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015992:Body Mass Index; D001835:Body Weight; D001853:Bone Marrow / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007223:Infant; D007938:Leukemia / Q000150:complications* / Q000401:mortality; D008297:Male; D018365:Neoplasm, Residual / Q000175:diagnosis; D009765:Obesity / Q000150:complications*; D050177:Overweight; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models