title: Association between body mass index at diagnosis and pediatric leukemia mortality and relapse: a systematic review and meta-analysis.
abstract: Obesity is a risk factor for mortality and relapse of certain cancers. However, existing evidence for pediatric leukemia is inconsistent. The aim of this systematic review and meta-analysis was to evaluate the association between obesity at diagnosis and pediatric acute leukemia mortality and relapse. This study systematically searched MEDLINE and EMBASE from inception to February 5, 2015. Random-effect models were used to generate pooled estimates of study-specific hazard ratios (HR) and 95% confidence intervals (CI). Eleven studies were included. An increased risk of mortality with a high BMI at diagnosis was observed (overall survival: HR=1.30, 95% CI=1.16-1.46 and event-free survival: HR=1.46, 95% CI=1.29-1.64). Only two studies reported HR for relapse; one reported a reduced risk, while the other reported an increased risk. A high BMI at diagnosis is associated with poor overall and event-free survival among pediatric acute leukemia patients. Targeted therapeutic approaches for obese pediatric leukemia patients may potentially improve survival outcomes.
authors.affiliation: a Clinical and Translational Research Organization, All Children's Research Institute, All Children's Hospital Johns Hopkins Medicine , St. Petersburg , FL , USA .|b Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA .|c Department of Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA .
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Amankwah
authors.affiliation: d Department of Epidemiology and Biostatistics , College of Public Health, University of South Florida , Tampa , FL , USA , and.
authors.forename: Ashleigh M
authors.initials: AM
authors.lastname: Saenz
authors.affiliation: b Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA .|c Department of Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA .|e All Children's Hospital Johns Hopkins Medicine , St. Petersburg , FL , USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.affiliation: b Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA .|c Department of Oncology , Johns Hopkins University School of Medicine , Baltimore , MD , USA .
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D009026:Mortality; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D017594:Publication Bias; D012008:Recurrence
keywords: Body mass index; mortality and relapse; obesity; pediatric acute leukemia