BACKGROUND: The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS: Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥ 85th percentile). RESULTS: Twenty-five patients (8%) were underweight, 86 patients (27.4%) were overweight/obese, and 203 patients (64.6%) had healthy weight. The 5-year overall survival rate of overweight/obese patients (46.5% ± 7.3%) was lower than the rate of patients with healthy weight (67.1% ± 4.3%; P < .001); underweight patients also tended to have lower survival rates (50.6% ± 10.7%; P = .18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P = .01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P = .03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P = .009). CONCLUSIONS: An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics-guided chemotherapy dosing, may improve outcome.
BACKGROUND: The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS:Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥ 85th percentile). RESULTS: Twenty-five patients (8%) were underweight, 86 patients (27.4%) were overweight/obese, and 203 patients (64.6%) had healthy weight. The 5-year overall survival rate of overweight/obesepatients (46.5% ± 7.3%) was lower than the rate of patients with healthy weight (67.1% ± 4.3%; P < .001); underweight patients also tended to have lower survival rates (50.6% ± 10.7%; P = .18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P = .01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P = .03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obesepatients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P = .009). CONCLUSIONS: An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics-guided chemotherapy dosing, may improve outcome.
Authors: R A Krance; C A Hurwitz; D R Head; S C Raimondi; F G Behm; K R Crews; D K Srivastava; H Mahmoud; W M Roberts; X Tong; R L Blakley; R C Ribeiro Journal: J Clin Oncol Date: 2001-06-01 Impact factor: 44.544
Authors: R Peto; M C Pike; P Armitage; N E Breslow; D R Cox; S V Howard; N Mantel; K McPherson; J Peto; P G Smith Journal: Br J Cancer Date: 1977-01 Impact factor: 7.640
Authors: Xiao-Cheng Wu; Pinki K Prasad; Ian Landry; Linda C Harlan; Helen M Parsons; Charles F Lynch; Ashley W Smith; Ann S Hamilton; Theresa H M Keegan Journal: Cancer Epidemiol Biomarkers Prev Date: 2015-09-29 Impact factor: 4.254
Authors: G Twig; N Geva; H Levine; E Derazne; N Goldberger; Z Haklai; A Leiba; J D Kark Journal: Int J Obes (Lond) Date: 2017-10-30 Impact factor: 5.095
Authors: Y Liu; C A Fernandez; C Smith; W Yang; C Cheng; J C Panetta; N Kornegay; C Liu; L B Ramsey; S E Karol; L J Janke; E C Larsen; N Winick; W L Carroll; M L Loh; E A Raetz; S P Hunger; M Devidas; J J Yang; C G Mullighan; J Zhang; W E Evans; S Jeha; C-H Pui; M V Relling Journal: Clin Pharmacol Ther Date: 2017-04-04 Impact factor: 6.875
Authors: Ditte J A Løhmann; Jonas Abrahamsson; Shau-Yin Ha; Ólafur G Jónsson; Minna Koskenvuo; Birgitte Lausen; Josefine Palle; Bernward Zeller; Henrik Hasle Journal: Haematologica Date: 2016-07-28 Impact factor: 9.941
Authors: Andrew M Brunner; Hossein Sadrzadeh; Yang Feng; Benjamin J Drapkin; Karen K Ballen; Eyal C Attar; Philip C Amrein; Steven L McAfee; Yi-Bin Chen; Donna S Neuberg; Amir T Fathi Journal: Am J Hematol Date: 2013-05-30 Impact factor: 10.047
Authors: Marissa A H den Hoed; Saskia M F Pluijm; Hester A de Groot-Kruseman; Mariël L te Winkel; Martha Fiocco; Erica L T van den Akker; Peter Hoogerbrugge; Henk van den Berg; Jan A Leeuw; Marrie C A Bruin; Dorine Bresters; Anjo J P Veerman; Rob Pieters; Marry M van den Heuvel-Eibrink Journal: Haematologica Date: 2014-10-10 Impact factor: 9.941