title: The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia.
abstract: The impact of body mass index (BMI) at diagnosis on treatment outcome in children with acute lymphoblastic leukemia (ALL) is controversial. We studied 373 children with ALL enrolled on the Total XV study, which prospectively used minimal residual disease (MRD) for risk assignment. MRD on day 19 and at the end of remission induction (day 46), cumulative incidence of relapse/refractory disease (CIR), event-free survival (EFS) and overall survival (OS) were evaluated using sets of four, three and two subgroups based on BMI at diagnosis, along with BMI percentile change during remission induction. Higher BMI was associated with older age and higher treatment risk. There was no association between MRD on days 19 or 46 and BMI for four, three or two BMI subgroups (P>0.1 in all cases), nor was BMI associated with CIR or EFS. Obese patients had worse OS compared with non-obese (P=0.031) due to treatment-related mortality and less salvage after refractory disease or bone marrow relapse. No association between BMI change during remission induction and MRD, CIR, EFS or OS was seen. BMI at diagnosis does not predict poorer response or relapse in a contemporary MRD-directed ALL regimen. Improvements in supportive care and innovative, less-toxic frontline/salvage therapies are needed, especially for obese patients.
authors.affiliation: Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Eissa
authors.affiliation: Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Panetta
authors.affiliation: Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Browne
authors.affiliation: Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.|Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jeha
authors.affiliation: Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Pharmaceutical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA.|Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Relling
authors.affiliation: Department of Pediatrics, National University of Singapore, Singapore, Singapore.
authors.forename: D
authors.initials: D
authors.lastname: Campana
authors.affiliation: Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.|Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: C-H
authors.initials: CH
authors.lastname: Pui
authors.affiliation: Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA.|Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: H
authors.initials: H
authors.lastname: Inaba
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome