title: Changes in body mass index in long-term survivors of childhood acute lymphoblastic leukemia treated without cranial radiation and with reduced glucocorticoid therapy.
abstract: Cranial radiation and glucocorticoids are associated with an increase in body mass index (BMI) z-score in survivors of childhood acute lymphoblastic leukemia (ALL). We aimed to investigate the impact of a contemporary treatment protocol that omitted prophylactic cranial radiation and glucocorticoids from the maintenance phase on longitudinal BMI, height, and weight z-scores in children with ALL.
  
  
  
  We retrospectively studied 184 children with standard- and medium-risk ALL treated without cranial radiation or glucocorticoids. Height, weight, and BMI z-scores were collected from diagnosis to 7 years after diagnosis. Longitudinal changes in anthropometric data were compared to diagnosis using separate linear mixed models, adjusting for age, sex, and socioeconomic status (SES).
  
  
  
  Relative to diagnosis, there was a significant increase in estimated marginal mean BMI z-score during dexamethasone-containing re-induction (1.08, P < 0.001) that persisted throughout intensification (0.85, P < 0.001) and maintenance phases (0.81, P < 0.001), and up to 7 years after diagnosis (0.76, P = 0.002). Height z-scores decreased over the same time (P < 0.001), whereas weight z-scores fluctuated during treatment and declined thereafter (P = 0.007). A higher BMI z-score at diagnosis was associated with a younger age (P < 0.001), male sex (P < 0.001), and lower SES (P < 0.001).
  
  
  
  Children who did not receive cranial radiation or glucocorticoids during maintenance remain at increased risk of treatment-related increases in BMI z-score, which is associated with a loss of height z-score. Interventions designed to mediate this risk should begin early, even while children are on treatment because of the association with cardiovascular risk. Monitoring of survivors of ALL should include anthropometric measures.
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Touyz
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia.|Department of Nutrition & Dietetics, Sydney Children's Hospital, Randwick, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia.|Department of Endocrinology, Sydney Children's Hospital, Randwick, Australia.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Neville
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Wakefield
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.|The Children's Hospital at Westmead Clinical School, University of Sydney, Westmead, Australia.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Garnett
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Kylie-Ann
authors.initials: KA
authors.lastname: Mallitt
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Grech
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, Australia.|Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cohn
mesh_terms: D000293:Adolescent; D001827:Body Height / Q000187:drug effects / Q000528:radiation effects; D015992:Body Mass Index; D001835:Body Weight / Q000187:drug effects / Q000528:radiation effects; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009367:Neoplasm Staging; D009765:Obesity / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017741:Survivors
chemical_list: D005938:Glucocorticoids
keywords: body mass index; glucocorticoids; overweight; pediatric; precursor cell lymphoblastic leukemia