title: Survivors of standard risk acute lymphoblastic leukemia do not have increased risk for overweight and obesity compared to non-cancer peers: a report from the Children's Oncology Group.
abstract: BACKGROUND
  We sought to determine whether survivors of standard risk ALL (SR-ALL) treated without cranial radiation have increased risk for obesity by assessing changes in body mass index (BMI) during and after treatment; identifying contributing patient and treatment factors; comparing rates of overweight/obese to national health data.
  
  
  METHODS
  Eligibility for this retrospective cohort study included: (i) previous enrollment on legacy therapy trials CCG1922 or CCG1952; (ii) continuous first remission; and (iii) age at follow-up evaluation of 6-16.99 years. Height and weight from diagnosis, consolidation, start of maintenance, last cycle of maintenance, and off-therapy were analyzed.
  
  
  RESULTS
  The 269 subjects were a median age of 3.5 years at diagnosis and 13.3 years at follow-up. BMI% significantly increased from induction to consolidation (+17.6 ± 1.6%), start of maintenance to end-of-treatment (+3.3 ± 1.6%) and decreased from end-of-treatment to follow-up (-3.5 ± 1.6%,). Higher BMI% at follow-up was associated with higher BMI% at diagnosis (P < 0.0001), but not age at diagnosis, gender, or race. Patients previously randomized to dexamethasone had a stronger association between BMI% at diagnosis and BMI% at follow-up than those who received prednisone (P = 0.0005). At follow-up, 39% of survivors were overweight or obese; the relative risk of overweight/obese was 1.028 (P = 0.738) compared to the general population.
  
  
  CONCLUSIONS
  Our study of patients with SR-ALL found a significant increase in BMI% largely during the first month of therapy that is greater with dexamethasone than prednisone. However, after therapy, there was no increased risk of overweight/obese BMI compared to non-cancer peers.
authors: Oregon Health & Science University, Doernbecher Children's Hospital, Portland, OR.
authors: Susan J
authors: SJ
authors: Lindemulder
authors: Linda C
authors: LC
authors: Stork
authors: Bruce
authors: B
authors: Bostrom
authors: Xiaomin
authors: X
authors: Lu
authors: Meenakshi
authors: M
authors: Devidas
authors: Stephen
authors: S
authors: Hunger
authors: Joseph P
authors: JP
authors: Neglia
authors: Nina S
authors: NS
authors: Kadan-Lottick
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D050177:Overweight / Q000209:etiology*; D063766:Pediatric Obesity / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000401:mortality / Q000532:radiotherapy; D012189:Retrospective Studies; D012306:Risk; D017741:Survivors
keywords: acute lymphoblastic leukemia; body mass index; cancer survivors; children; obesity