title: Effect of Initial Body Mass Index on Survival Outcome of Patients With Acute Leukemia: A Single-Center Retrospective Study.
abstract: BACKGROUND
  Obesity is associated with an increased risk of mortality from cardiovascular causes and occurrence of malignancies. However, the effect of body mass index (BMI) on survival outcome remains controversial in acute leukemia (AL) patients.
  
  
  METHODS
  A total of 531 adults with AL who entered clinical trials in our institution between 1994 and 2012 were analyzed retrospectively for the effect of BMI at diagnosis on outcome. The median follow-up was 4.7 years (95% confidence interval [CI], 4.0-5.1).
  
  
  RESULTS
  BMI had no significant effect on complete response rate, disease-free survival (DFS), or overall survival (OS) in patients from the whole cohort when considering a cutoff value for BMI of 25, and when analyzed according to age, or initial cytogenetics. In T-acute lymphoblastic leukemia (T-ALL) patients with BMI > 25, median DFS was not reached with a 3-year DFS at 76%, and median DFS was 16.1 months with 3-year DFS at 13% for those with BMI ≤ 25 (P = .005). Median OS was not reached in T-ALL patients with BMI > 25 versus 28.3 months in those with BMI ≤ 25 (3-year OS: 78% vs. 41%; P = .04). Multivariate analyses confirmed the prognostic value of BMI (> 25 vs. < 25) in T-ALL, but only in terms of DFS (hazard ratio, 0.25; 95% CI, 0.05-0.87; P = .037). However, in a validation cohort of 211 T-ALL patients, these results were not confirmed.
  
  
  CONCLUSIONS
  Results from the literature are very heterogeneous and contradictory regarding the effect of BMI on leukemia outcome. Even if nutritional status during chemotherapy courses is critical, these findings provide further evidence that initial body size does not have a major prognostic effect on survival in AL patients.
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France.
authors: Maël
authors: M
authors: Heiblig
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France.
authors: Mohamed
authors: M
authors: Elhamri
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France.
authors: Franck E
authors: FE
authors: Nicolini
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France.
authors: Eric
authors: E
authors: Wattel
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France.
authors: Mauricette
authors: M
authors: Michallet
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France.
authors: Gilles
authors: G
authors: Salles
authors: Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pierre Bénite, France. Electronic address: xavier.thomas@chu-lyon.fr.
authors: Xavier
authors: X
authors: Thomas
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007938:Leukemia / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acute leukemia; Body mass index; Overweight; Prognosis; T-cell lineage acute lymphoblastic leukemia