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Diet, Exercise Enhance Effects of Chemotherapy, Odds of Survival for Youth With ALL


Patients who cut their calorie intake by at least 10% and exercised modestly were 70% less likely to have remaining leukemic cells in their bone marrow 1 month after starting chemotherapy, according to results of an early study.

There’s a growing body of research pointing to social factors impacting the health of patients with different diseases and conditions, and a recent proof-of-concept prospective study is revealing what a healthy lifestyle can do for leukemic outcomes.

According to the recent study, published in Blood Advances, diet and exercise can help increase the odds of survival in younger patients with acute lymphoblastic leukemia (ALL). Results showed that patients who cut their calorie intake by at least 10% and exercised modestly were 70% less likely to have remaining leukemic cells in their bone marrow 1 month after starting chemotherapy.

Previous research has indicated that being overweight or obese is associated with chemotherapy resistance and having obesity when beginning chemotherapy puts patients at a more than 2-fold risk of having remaining cancer cells a month after treatment.

“To our knowledge, this is the first study to show that by limiting calories and increasing exercise we can make chemotherapy more effective in eliminating leukemia cells within the first month of therapy, decreasing the chances of disease relapse in children and adolescents,” commented Etan Orgel, MD, MS, Director of the Medical Supportive Care Service in the Cancer and Blood Disease Institute at Children’s Hospital Los Angeles and principal investigator of the study, in a statement.

Orgel and researchers recruited 40 patients aged 10 to 21 years who were newly diagnosed with B-cell ALL and worked with registered dietitians and physical therapists to create individualized diet and exercise plans for each patient.

While the lifestyle adjustments did not result in a significant reduction in fat gain among these patients compared with historical controls, post hoc analyses that stratified patients according to body mass index highlighted how diet and exercise impacted patients who were overweight or obese differently than patients considered lean.

As patients limited fat, they also lowered their insulin resistance and increased their levels of adiponectin, a metabolic hormone with ties to glucose regulation; the researchers said identifying these potential biomarkers could lay the foundation for using this type of intervention in other cancers.

“Changing diet and exercise made the chemotherapy work better—that’s the big news of this study. But we also need to figure out how,” said Steven Mittelman, MD, PhD, Chief of Pediatric Endocrinology at UCLA Mattel Children’s Hospital and member of UCLA’s Jonsson Comprehensive Cancer Center, and senior author of the study, in a statement. “Understanding the biological changes responsible for this effect will help us make these interventions even better.”

The researchers note that a prospective, randomized trial is needed to validate these findings.


Orgel E, Framson C, Buxton R, et al. Caloric and nutrient restriction to augment chemotherapy efficacy for acute lymphoblastic leukemia: the IDEAL trial. Blood Adv. 2021;5(7):1853-1861. doi: 10.1182/bloodadvances.2020004018

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