Emily K Browne1, Yinmei Zhou2, Wassim Chemaitilly1, John C Panetta3, Kirsten K Ness4, Sue C Kaste5,6,7, Cheng Cheng2, Mary V Relling3,8, Ching-Hon Pui6,9, Hiroto Inaba6,9. 1. Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee. 2. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee. 3. Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee. 4. Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee. 5. Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee. 6. Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. 7. Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee. 8. Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee. 9. Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee.
Abstract
BACKGROUND: Children with acute lymphoblastic leukemia (ALL) have an increased risk of obesity and short stature. To the authors' knowledge, data regarding patients treated on contemporary protocols without cranial irradiation are limited. METHODS: Changes in z scores for body mass index (BMI), height, and weight from the time of diagnosis to 5 years off therapy were evaluated using multivariable analysis in 372 children with ALL who were aged 2 to 18 years at the time of diagnosis and were enrolled on the St. Jude Children's Research Hospital Total XV protocol from 2000 through 2007. RESULTS: The percentage of overweight/obese patients increased from 25.5% at the time of diagnosis to approximately 50% during the off-therapy period. Median BMI z scores increased significantly during glucocorticoid therapy (induction: ∆0.56; 95% confidence interval [95% CI], 0.29-0.64 [P<.001]; and reinduction II: ∆0.22; 95% CI, 0.13-0.49 [P=.001]) and during the first year after therapy (∆0.18; 95% CI, 0.08-0.46 [P=.006]). Among patients who were of healthy weight/underweight at the time of diagnosis, those aged 2 to <10 years at diagnosis had a significantly higher risk of becoming overweight/obese during or after therapy compared with those aged ≥10 years (P=.001). Height z scores declined during treatment and improved after therapy. Being aged 2 to <10 years at the time of diagnosis, being of low-risk status, having a white blood cell count < 50×109 /L at the time of diagnosis, and having negative central nervous system disease were associated with significantly better improvements in z scores for height during the off-therapy period compared with being aged ≥10 years, being of standard-risk/high-risk status, having a white blood cell count ≥ 50×109 /L, and having positive central nervous system disease, respectively. CONCLUSIONS: The results of the current study demonstrate that obesity is prevalent, and height growth, especially in patients with identified risk factors, appears compromised. Multidisciplinary intervention should begin during induction therapy and continue during the off-therapy period.
BACKGROUND:Children with acute lymphoblastic leukemia (ALL) have an increased risk of obesity and short stature. To the authors' knowledge, data regarding patients treated on contemporary protocols without cranial irradiation are limited. METHODS: Changes in z scores for body mass index (BMI), height, and weight from the time of diagnosis to 5 years off therapy were evaluated using multivariable analysis in 372 children with ALL who were aged 2 to 18 years at the time of diagnosis and were enrolled on the St. Jude Children's Research Hospital Total XV protocol from 2000 through 2007. RESULTS: The percentage of overweight/obesepatients increased from 25.5% at the time of diagnosis to approximately 50% during the off-therapy period. Median BMI z scores increased significantly during glucocorticoid therapy (induction: ∆0.56; 95% confidence interval [95% CI], 0.29-0.64 [P<.001]; and reinduction II: ∆0.22; 95% CI, 0.13-0.49 [P=.001]) and during the first year after therapy (∆0.18; 95% CI, 0.08-0.46 [P=.006]). Among patients who were of healthy weight/underweight at the time of diagnosis, those aged 2 to <10 years at diagnosis had a significantly higher risk of becoming overweight/obese during or after therapy compared with those aged ≥10 years (P=.001). Height z scores declined during treatment and improved after therapy. Being aged 2 to <10 years at the time of diagnosis, being of low-risk status, having a white blood cell count < 50×109 /L at the time of diagnosis, and having negative central nervous system disease were associated with significantly better improvements in z scores for height during the off-therapy period compared with being aged ≥10 years, being of standard-risk/high-risk status, having a white blood cell count ≥ 50×109 /L, and having positive central nervous system disease, respectively. CONCLUSIONS: The results of the current study demonstrate that obesity is prevalent, and height growth, especially in patients with identified risk factors, appears compromised. Multidisciplinary intervention should begin during induction therapy and continue during the off-therapy period.
Authors: Joanne M Spahn; Rebecca S Reeves; Kathryn S Keim; Ida Laquatra; Molly Kellogg; Bonnie Jortberg; Nicole A Clark Journal: J Am Diet Assoc Date: 2010-06
Authors: Lisa Diller; Eric J Chow; James G Gurney; Melissa M Hudson; Nina S Kadin-Lottick; Toana I Kawashima; Wendy M Leisenring; Lillian R Meacham; Ann C Mertens; Daniel A Mulrooney; Kevin C Oeffinger; Roger J Packer; Leslie L Robison; Charles A Sklar Journal: J Clin Oncol Date: 2009-04-13 Impact factor: 44.544
Authors: Cynthia L Ogden; Margaret D Carroll; Hannah G Lawman; Cheryl D Fryar; Deanna Kruszon-Moran; Brian K Kit; Katherine M Flegal Journal: JAMA Date: 2016-06-07 Impact factor: 56.272
Authors: Jennifer Cohen; Claire E Wakefield; Linda C Tapsell; Karen Walton; Catharine A K Fleming; Richard J Cohn Journal: Support Care Cancer Date: 2014-08-17 Impact factor: 3.603
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: Jennifer A Ligibel; Catherine M Alfano; Kerry S Courneya; Wendy Demark-Wahnefried; Robert A Burger; Rowan T Chlebowski; Carol J Fabian; Ayca Gucalp; Dawn L Hershman; Melissa M Hudson; Lee W Jones; Madhuri Kakarala; Kirsten K Ness; Janette K Merrill; Dana S Wollins; Clifford A Hudis Journal: J Clin Oncol Date: 2014-10-01 Impact factor: 44.544
Authors: C Sklar; A Mertens; A Walter; D Mitchell; M Nesbit; M O'Leary; R Hutchinson; A Meadows; L Robison Journal: J Pediatr Date: 1993-07 Impact factor: 4.406
Authors: Virginia Kimball Dalton; Montse Rue; Lewis B Silverman; Richard D Gelber; Barbara L Asselin; Ronald D Barr; Luis A Clavell; Craig A Hurwitz; Albert Moghrabi; Yvan Samson; Marshall Schorin; Nancy J Tarbell; Stephen E Sallan; Laurie E Cohen Journal: J Clin Oncol Date: 2003-08-01 Impact factor: 44.544
Authors: Bonnie A Spear; Sarah E Barlow; Chris Ervin; David S Ludwig; Brian E Saelens; Karen E Schetzina; Elsie M Taveras Journal: Pediatrics Date: 2007-12 Impact factor: 7.124
Authors: Mayuko Iijima; Wei Liu; John C Panetta; Melissa M Hudson; Ching-Hon Pui; Deo Kumar Srivastava; Kevin R Krull; Hiroto Inaba Journal: Cancer Date: 2021-04-29 Impact factor: 6.921
Authors: Kayla L Foster; Kathleen D Kern; Tiffany M Chambers; Philip J Lupo; Kala Y Kamdar; Michael E Scheurer; Austin L Brown Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240
Authors: Alissa W Zhang; John T Wiernikowski; Carol Portwine; Lehana Thabane; M Constantine Samaan Journal: Sci Rep Date: 2022-01-26 Impact factor: 4.379
Authors: Daniel V Runco; Karen Wasilewski-Masker; Claire M Mazewski; Briana C Patterson; Ann C Mertens Journal: J Pediatr Hematol Oncol Date: 2021-11-01 Impact factor: 1.170