BACKGROUND: Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. PROCEDURE: In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000 to 2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. RESULTS: At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z-score at diagnosis was associated with increased z-score during maintenance (P < 0.001). Elevated parental BMI was associated with elevated BMI at diagnosis. Median BMI z-score increased over the first 22 months of maintenance (P < 0.001). Patients with high risk disease had lower BMI z-scores regardless of cranial radiotherapy exposure (P < 0.001). Pre-hypertension was prevalent over the course of therapy (31.1% with systolic pre-hypertension and 18.6% with diastolic pre-hypertension). Hypertension was also highly prevalent with 41.5% meeting systolic criteria and 24.0% meeting diastolic criteria. CONCLUSIONS: During ALL therapy, patients are at risk for early development of elevated BMI and blood pressure, which places them at potentially increased risk for future adverse health conditions. Future studies are needed to develop strategies to mitigate these risks, such as potential reduction of corticosteroid pulses or a family-based diet and exercise intervention during maintenance therapy.
BACKGROUND:Obesity and hypertension are reported among survivors of pediatric acute lymphoblastic leukemia (ALL). However, little is known about the trajectory of body mass index (BMI) and blood pressure over the course of ALL therapy. PROCEDURE: In a retrospective cohort of 183 pediatric ALL patients diagnosed from 2000 to 2008, prevalence, severity, and risk factors for obesity and hypertension were assessed during treatment. RESULTS: At diagnosis, 36% of patients were overweight and 19% were obese. Median BMI increased during induction therapy with a return to baseline soon after, but increased again over the first 22 months of maintenance therapy. At the end of therapy, 49% were overweight and 21% were obese. Increased BMI z-score at diagnosis was associated with increased z-score during maintenance (P < 0.001). Elevated parental BMI was associated with elevated BMI at diagnosis. Median BMI z-score increased over the first 22 months of maintenance (P < 0.001). Patients with high risk disease had lower BMI z-scores regardless of cranial radiotherapy exposure (P < 0.001). Pre-hypertension was prevalent over the course of therapy (31.1% with systolic pre-hypertension and 18.6% with diastolic pre-hypertension). Hypertension was also highly prevalent with 41.5% meeting systolic criteria and 24.0% meeting diastolic criteria. CONCLUSIONS: During ALL therapy, patients are at risk for early development of elevated BMI and blood pressure, which places them at potentially increased risk for future adverse health conditions. Future studies are needed to develop strategies to mitigate these risks, such as potential reduction of corticosteroid pulses or a family-based diet and exercise intervention during maintenance therapy.
Authors: C A Sklar; A C Mertens; A Walter; D Mitchell; M E Nesbit; M O'Leary; R Hutchinson; A T Meadows; L L Robison Journal: Med Pediatr Oncol Date: 2000-08
Authors: Cynthia L Ogden; Robert J Kuczmarski; Katherine M Flegal; Zuguo Mei; Shumei Guo; Rong Wei; Laurence M Grummer-Strawn; Lester R Curtin; Alex F Roche; Clifford L Johnson Journal: Pediatrics Date: 2002-01 Impact factor: 7.124
Authors: K G M M Alberti; Robert H Eckel; Scott M Grundy; Paul Z Zimmet; James I Cleeman; Karen A Donato; Jean-Charles Fruchart; W Philip T James; Catherine M Loria; Sidney C Smith Journal: Circulation Date: 2009-10-05 Impact factor: 29.690
Authors: Kevin C Oeffinger; Ann C Mertens; Charles A Sklar; Yutaka Yasui; Thomas Fears; Marilyn Stovall; Terry A Vik; Peter D Inskip; Leslie L Robison Journal: J Clin Oncol Date: 2003-04-01 Impact factor: 50.717
Authors: Gilbert P August; Sonia Caprio; Ilene Fennoy; Michael Freemark; Francine R Kaufman; Robert H Lustig; Janet H Silverstein; Phyllis W Speiser; Dennis M Styne; Victor M Montori Journal: J Clin Endocrinol Metab Date: 2008-09-09 Impact factor: 5.958
Authors: Susan J Lindemulder; Linda C Stork; Bruce Bostrom; Xiaomin Lu; Meenakshi Devidas; Stephen Hunger; Joseph P Neglia; Nina S Kadan-Lottick Journal: Pediatr Blood Cancer Date: 2015-02-07 Impact factor: 3.167
Authors: Fang Fang Zhang; Michael J Kelly; Edward Saltzman; Aviva Must; Susan B Roberts; Susan K Parsons Journal: Pediatrics Date: 2014-02-17 Impact factor: 7.124
Authors: Marie-Louise Hyre Arpe; Sascha Rørvig; Karin Kok; Christian Mølgaard; Thomas Leth Frandsen Journal: Support Care Cancer Date: 2015-04-17 Impact factor: 3.603
Authors: Emily K Browne; Yinmei Zhou; Wassim Chemaitilly; John C Panetta; Kirsten K Ness; Sue C Kaste; Cheng Cheng; Mary V Relling; Ching-Hon Pui; Hiroto Inaba Journal: Cancer Date: 2018-10-25 Impact factor: 6.860
Authors: Adam J Esbenshade; Jill H Simmons; Tatsuki Koyama; Robert B Lindell; Debra L Friedman Journal: Pediatr Blood Cancer Date: 2013-02-26 Impact factor: 3.167
Authors: Eric J Chow; Catherine Pihoker; Debra L Friedman; Stephanie J Lee; Jeannine S McCune; Claire Wharton; Christian L Roth; K Scott Baker Journal: Pediatr Blood Cancer Date: 2012-10-05 Impact factor: 3.167