Early Weight Gain and Obesity in Childhood Acute Lymphoblastic Leukemia
AuthorWithycombe, Janice Squires
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PublisherThe University of Arizona.
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AbstractObesity is a recognized problem for children treated for acute lymphoblastic leukemia (ALL) and is present in roughly one fourth of children by the end of therapy. Obesity may lead to immediate health threats, such as an increased risk for cancer relapse, or may cause future heath issues such as diabetes, metabolic syndrome, hypertension, additional cancers, depression or cardiovascular disease. The purpose of this study was to determine if weight gain during two individual cycles of therapy (Induction or Delayed Intensification Cycle 1) were predictive of obesity (defined as body mass index ≥ 95th percentile for age and gender) at the end of treatment. This study retrospectively examined height and weight data from 1,017 childhood leukemia patients treated on Children's Oncology Group (COG) protocol number 1961. This study included patients that had fully completed therapy on protocol 1961 and who were between the ages of 2-20 years. Percentiles and z-scores for age and gender specific body mass index (BMI) were calculated using the height and weight measurements obtained at the beginning of each cycle of chemotherapy. Univariate and multivariate logistic regression analyses were performed. BMI z-score at the beginning of therapy and difference in BMI z-score during Induction were significant predictors (p<0.0001) of BMI ≥ 95th percentile at the end of maintenance in both males and females. A one unit increase in the difference of BMI z-score during Induction resulted in a 3.03 odds ratio (OR) for obesity at the end of therapy for males (95% CI, 1.90 to 4.84) and a 4.15 OR for females (95% CI, 2.32 to 7.43). The change in BMI z-score during Delayed Intensification I was not found to be significant in relationship to obesity at the end of therapy. Weight gain during Induction consisted of ≥ 20% increase in weight for 3.9% of the study participants. Weight gain during Induction therapy of childhood ALL treatment may be useful in predicting patients at increased risk for obesity development during therapy. Early identification of these at risk patients can assist with interventions aimed at normalizing weight gain during therapy.
Degree ProgramGraduate College