The Impact of High BMI on Outcomes, Treatment Efficacy in ALL

High BMI affects outcomes in ALL, highlighting the need for targeted interventions to improve patient survival rates and treatment efficacy. | Image credit: Studio Romantic - stock.adobe.com

Elevated body mass index (BMI) is a modifiable risk factor in acute lymphoblastic leukemia (ALL), with high BMI impacting patient outcomes and treatment efficacy. Two posters presented at the annual meeting of the American Society of Clinical Oncology evaluated the impact of BMI: one reported on the safety and efficacy of inotuzumab ozogamicin (InO) stratified by BMI, and the other analyzed how high BMI correlates to deaths and disability-adjusted life years (DALYs) and identified global trends over a 30-year period.^1,2

BMI on Outcomes for Inotuzumab Ozogamicin

InO is approved to treat adults with relapsed/refractory B-cell precursor acute lymphoblastic leukemia,³ but elevated BMI is known to produce worse outcomes. The researchers pooled data from 338 participants in 3 previous studies (NCT01363297, NCT01564784, and NCT03677596).¹ The participants were grouped by formal BMI definitions: less than 25 kg/m² (healthy), 25-30 kg/m² (overweight) and more than 30 kg/m² (obese).

The patients included had a median age of 44 years with 41% female. There were 155 patients with healthy BMI, 116 with overweight BMI, and 67 patients with obese BMI.

They found that 70% of patients with healthy BMI, 76% with overweight BMI, and 69% with obese BMI achieved complete remission (CR)/CR with incomplete count recovery, and 56% with healthy BMI, 63% with overweight BMI, and 52% with obese BMI achieved minimal residual disease negativity.

Regarding survival probabilities, patients with healthy BMI clearly fared better. At 24 months:

• The probability of progression-free survival was 19.9% for healthy BMI, 12.8% for overweight BMI, and 10.9% for obese BMI
• The probability of survival was 28.1% for healthy BMI, 22.1% for overweight BMI, and 17.5% for obese BMI

The incidence of treatment-emergent adverse events was similar across BMI groups. The proportion of patients who went on to receive hematopoietic stem cell transplantation was similar across groups (40% to 43%), as was the rates of non-relapse mortality within 100 days of HSCT (19% to 22%).

Overall, the researchers concluded that while efficacy and safety outcomes were mostly consistent across the groups, patients with higher BMI did have lower progression-free survival and overall survival rates at 24 months.

Impact of BMI on ALL: Global Trends

In the second poster,² researchers used data from the Global Burden of Diseases database to assess the DALYs and deaths attributable to ALL from 1990 to 2021. They found DALYs attributed to high BMI increased steadily over the time period, but deaths remained largely stable with a modest increase over the 30 years.

The age-standardized mortality ratio also gradually increased over the years. There was a strong correlation between DALYs and deaths and with a growing DALY burden, the researchers noted increased non-fatal impairments and life-years lost due to disability for patients.

“This study demonstrates the escalating burden of high BMI as a risk factor for ALL, primarily driven by a rise in DALYs rather than a proportional increase in mortality,” they concluded. “These findings highlight the need for targeted interventions to mitigate high BMI's impact, emphasizing preventative measures and improved management strategies to reduce both the fatal and non-fatal burden associated with ALL.”

References

1. Stock W, Cassaday R, DeAngelo D, et al. Outcomes in patients with B-cell precursor acute lymphoblastic leukemia receiving inotuzumab ozogamicin stratified by body mass index. Presented at: ASCO 2025; May 30-June 3, 2025; Chicago, Illinois. Abstract 6541.

2. Dixit A, Sahu S, Iftikhar S, et al. Assessing the impact of high body mass index on acute lymphoblastic leukemia: a 30-year global analysis. Presented at: ASCO 2025; May 30-June 3, 2025; Chicago, Illinois. Abstract e18536.

3. FDA approves inotuzumab ozogamicin for relapsed or refractory B-cell precursor ALL. News release. FDA. August 17, 2017. Accessed June 18, 2025. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-inotuzumab-ozogamicin-relapsed-or-refractory-b-cell-precursor-all