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Therapy-related changes in body size in Hispanic children with acute lymphoblastic leukemia
Jacques Baillargeon1, Anne-Marie Langevin, Margaret Lewis
1Center for Epidemiology and Biostatistics, University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA. baillargeon@uthscsa.edu
Insights
Pediatric patients with acute lymphoblastic leukemia (ALL) showed increasing body mass index (BMI) during chemotherapy, particularly those starting treatment at a normal weight. This highlights a risk for weight gain during leukemia therapy in children.
Area of Science:
- Pediatric Oncology
- Clinical Research
- Biostatistics
Background:
- Childhood cancer treatment, specifically chemotherapy for B-precursor acute lymphoblastic leukemia (ALL), can impact patient weight.
- Obesity is a known issue in long-term survivors of childhood ALL, but weight changes during therapy are less understood.
Purpose of the Study:
- To investigate longitudinal changes in body mass index (BMI) among pediatric patients undergoing chemotherapy for B-precursor acute lymphoblastic leukemia (ALL).
- To identify patterns of BMI changes from diagnosis through the completion of chemotherapy.
Main Methods:
- A cohort of 141 white Hispanic pediatric patients diagnosed with ALL between 1993 and 2002 was analyzed.
- Age-standardized and gender-standardized BMI scores were assessed over time during chemotherapy treatment.
- Repeated-measures analysis was employed to evaluate the significance of time and baseline BMI interactions.
Main Results:
- BMI scores steadily increased during the first 12 months of therapy, with modest increases at later intervals (18-29 months).
- A slight decrease in BMI was observed around 30 months (end of therapy).
- Significant effects were found for time (P = 0.019) and the interaction between time and baseline BMI category (P = 0.0001).
Conclusions:
- BMI scores in Hispanic children with ALL were elevated at diagnosis and remained elevated throughout chemotherapy.
- Patients with normal weight at diagnosis showed increased BMI over time, while overweight and obese patients had stable or slightly declining BMI.
- The risk of chemotherapy-related weight gain appears highest in children who initiate ALL therapy at a normal weight.
Background:
The objective of this study was to examine changes over time in body mass index (BMI) from diagnosis through chemotherapy for pediatric patients with B-precursor acute lymphoblastic leukemia (ALL).
Methods:
The study cohort consisted of 141 white Hispanic pediatric patients who were diagnosed with ALL and were treated at 2 South Texas pediatric oncology centers between 1993 and 2002. Changes in age-standardized and gender-standardized BMI scores were assessed.
Results:
The study cohort exhibited a steady increase in age-adjusted and gender-adjusted BMI scores for the first 12 months of therapy, a modest increase in BMI scores during the 18-23 month and 24-29 month periods, followed by a slight decrease in BMI scores at 30 months (end of therapy). A repeated-measures analysis indicated significant effects for time (P = 0.019) and time by baseline BMI category interaction (P = 0.0001) but no significant interaction effect between time and gender (P = 0.65).
Conclusions:
Although it is known that leukemia therapy is associated with prevalent obesity in survivorship, its pattern of development during therapy has not been elucidated. In the current cohort of Hispanic children with ALL, BMI scores were elevated at diagnosis (mean +/- standard deviation standardized BMI Z score, 0.33 +/- 1.4), then increased, and remained elevated for the entire duration of chemotherapy. Patients who were classified as normal weight exhibited an increase in BMI over time; patients who were classified as overweight at diagnosis exhibited BMI patterns that were relatively stable; and patients who were classified as obese exhibited a very slight decline over time. These findings suggest that the risk for chemotherapy-related weight gain applies predominantly to children who begin ALL therapy within a normal weight range.
