Obesity's Impact on Prognosis in Ph-Like Acute Lymphoblastic Leukemia

Obesity is associated with chemotherapy resistance and poorer survival in pediatric high-risk B-lymphoblastic leukemia (B-ALL). Philadelphia-like (Ph-like) B-ALL is a high-risk subset associated with poor outcomes. Our prior work linked CRLF2-overexpressed Ph-like B-ALL with obesity. However, the prognostic impact of obesity in Ph-like B-ALL has not been defined. Patients with end-of-induction measurable residual disease (EOI MRD)-positivity did poorly regardless of obesity status; however, among patients with EOI MRD-negativity, obesity was associated with inferior event-free survival (EFS) (3-year EFS 59% vs. 100%, p = 0.014). These data support obesity as a poor prognostic factor in Ph-like B-ALL, even among patients achieving early remission.