title: Increased Body Mass Index during Therapy for Childhood Acute Lymphoblastic Leukemia: A Significant and Underestimated Complication.
abstract: Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols (n = 80) to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI z-scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% (P < 0.004) for females but remained relatively unchanged for males (9.8% to 13.7%, P = 0.7). Longitudinal analysis using linear mixed-effects identified associations between BMI z-scores and time-dependent interactions with sex (P = 0.0005), disease risk (P < 0.0001), age (P = 0.0001), and BMI z-score (P < 0.0001) at diagnosis and total dose of steroid during maintenance (P = 0.01). Predicted mean BMI z-scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL.
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Atkinson
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Marsh
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia ; Department of Endocrinology, Princess Margaret Hospital, Perth, WA 6008, Australia.
authors.forename: Shoshana R
authors.initials: SR
authors.lastname: Rath
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia ; Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia ; Department of Oncology and Haematology, Princess Margaret Hospital, Perth, WA 6008, Australia.
authors.forename: Rishi S
authors.initials: RS
authors.lastname: Kotecha
authors.affiliation: Department of Oncology and Haematology, Princess Margaret Hospital, Perth, WA 6008, Australia.
authors.forename: Hazel
authors.identifier: 0000-0003-3745-4201
authors.initials: H
authors.lastname: Gough
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia.
authors.forename: Mandy
authors.identifier: 0000-0001-7669-6081
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Department of Oncology and Haematology, Princess Margaret Hospital, Perth, WA 6008, Australia.
authors.forename: Thomas
authors.identifier: 0000-0003-1461-4612
authors.initials: T
authors.lastname: Walwyn
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia ; Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia ; Department of Oncology and Haematology, Princess Margaret Hospital, Perth, WA 6008, Australia.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Gottardo
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia ; Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia ; Department of Oncology and Haematology, Princess Margaret Hospital, Perth, WA 6008, Australia ; PathWest, Perth, WA 6008, Australia.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Cole
authors.affiliation: School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia ; Department of Endocrinology, Princess Margaret Hospital, Perth, WA 6008, Australia.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Choong