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在患有急性淋巴细胞白血病的儿童中超重或肥胖和结果

Elena J Ladas¹, Haiyang Sheng², Uma H Athale³

¹Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Columbia University Irving Medical Center, New York, New York.

JAMA network open

|May 14, 2025

概括

患有急性淋巴细胞白血病 (ALL) 的儿童超重或肥胖的持续时间较长与生存率较差和复发率增加有关. 针对ALL治疗期间超重的干预措施对于更好的结果至关重要.

科学领域:

儿科瘤学儿科瘤学
临床研究临床研究
流行病学流行病学

背景情况:

关于超重/肥胖对儿童急性淋巴细胞白血病 (ALL) 临床结果的影响存在相互矛盾的数据.
暴露于超重或肥胖的持续时间可能是不良结果的更重要的预测因素,而不是间歇性的存在.

研究的目的:

调查超重或肥胖的持续时间与治疗相关的毒性影响,最小残留疾病,复发和小儿ALL患者的存活率之间的关联.
为了确定治疗期间长期超重或肥胖是否会影响关键的临床结果.

主要方法:

一项前性队列研究,涉及794名在2005年5月至2011年12月期间被诊断患有ALL的儿童.
身体质量指数 (BMI) z-分数从诊断到治疗结束 (EOT) 和生存率都被跟踪.
超重/肥胖的持续时间被定义为存在于两个或更多时间点,而不是一个或更少的时间点.

主要成果:

超重或肥胖的患病率从诊断时的29.5%增加到EOT时的48.4%.
在两个或两个以上时间点超重或肥胖的儿童的整体存活率 (OS) 和无事件存活率 (EFS) 显著下降,复发率更高.
多变量分析表明,长期超重或肥胖与死亡 (HR, 3.49) 和复发 (HR, 1.92) 的风险增加有关.

结论:

在儿童时期超重或肥胖的持续时间较长,ALL治疗与生存率较差和复发率增加有关.
这些发现凸显了对管理超重和肥胖的儿童进行ALL治疗的干预措施的迫切需要.
在治疗期间解决体重状况可能会改善儿科ALL幸存者的长期结果.

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