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ALL Treatment May Increase Weight Gain, Suppress Growth in Children, Teens

David Bai, PharmD
Children and adolescents with acute lymphoblastic leukemia (ALL) face an increased risk of obesity and growth impairment from the disease and during ALL treatment, regardless of exposure to cranial irradiation, according to a recent study.
 
Children and adolescents with acute lymphoblastic leukemia (ALL) face an increased risk of obesity and growth impairment from the disease and during ALL treatment, regardless of exposure to cranial irradiation, according to a recent study.

In recent years, the obesity rate in children has dramatically increased, not only because of lifestyle changes but also certain comorbidities. Children with ALL are one of the populations predisposed to becoming overweight as well as having growth suppression. Cranial irradiation, a treatment for ALL, may be involved in reductions of linear growth, but investigators do not know if any other inventions will affect growth and body weight.

In this study, investigators evaluated body mass index (BMI), height, and weight in patients with ALL during and after treatment to determine if the interventions involved affected these parameters.

Children and adolescents with ALL between 1 to 18 years old were enrolled from 2000 to 2007. Some of the patient stratifications included time of diagnosis (age 2 to <10 years old vs ≥ 10 years old), white blood cell count (WBC) at time of diagnosis (<50 x 109 /L vs ≥50 x 109/L), and central nervous system disease status (CNS-1 vs 2 vs 3). Treatment was divided into 3 phases: induction, consolidation, and continuation. Prednisone was given during induction while dexamethasone was given during continuation. Intrathecal treatment was given to patients with high CNS risk status.

A total of 372 children were included in this study. Median BMI z scores at all time points except day 19 of induction was significantly higher than at the time of diagnosis (P ≤ .015). The only other exception was between weeks 96 and 120 after the discontinuation of dexamethasone pulses. Median z scores for height also decreased during ALL therapy after diagnosis. After week 1, median z scores were significantly lower than at diagnosis (P ≤ .008). During the off-therapy period, z scores for height did improve; however, they never reached the same levels they originally were at diagnosis. Median z scores for weight, similarly to BMI, were significantly higher than time of diagnosis (P ≤ .041). The only time where the median z scores for weight decreased was between weeks 96 to 120, the same time when BMI decreased due to discontinuation of dexamethasone pulses.

Patient characteristics also affected these z score endpoints. Patients aged 2 to <10 years old at diagnosis tended to have higher median BMI z scores and a significantly higher risk of becoming overweight than those aged ≥10 years (P = .001). Patients who were black, male, and stratified as low-risk also had higher median z scores for BMI at certain time frames. Median z scores for height were lower for patients aged 2 to <10 years at diagnosis compared with patients aged ≥10 years at diagnosis (P = .011). Median z scores for height also were lower for patients classified as high or standard risk, had WBCs ≥50 x 109/L, greater CNS disease, were female, and black. Median z scores for weight were higher for patients aged 2 to <10 years at diagnosis after 1 year off therapy. Scores for weight were also higher for low-risk patients, males, and black patients.

This study has shown that BMI and weight z scores increased while height z scores decreased with ALL treatment for children and adolescents. In addition, certain patient demographics or characteristics seemed to weigh in on z scores such as race, gender, WBC, and risk stratification. Because obesity and impaired growth have led to physical and psychological comorbidities, clinicians should impose early lifestyle interventions while these patients with ALL are on treatment.

Reference

Browne EK, Zhou Y, Chemaitilly W, et al. Changes in body mass index, height, and weight in children during and after therapy for acute lymphoblastic leukemia [published online October 25, 2018]. Cancer. doi: 10.1002/cncr.31736.

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