Obesity as a predictor of treatment‐related toxicity in children with acute lymphoblastic leukaemia. (2nd November 2021)

• Record Type: Journal Article
• Authors: Egnell, Christina; Heyman, Mats; Jónsson, Ólafur Gisli; Raja, Raheel A.; Niinimäki, Riitta; Albertsen, Birgitte Klug; Schmiegelow, Kjeld; Stabell, Niklas; Vaitkeviciene, Goda; Lepik, Kristi; Harila‐Saari, Arja; Ranta, Susanna
• Is Part Of: British journal of haematology. Volume 196:Number 5(2022)
• Page Start: 1239
• Page End: 1247
• Publication Date: 2021-11-02
• Subjects: body mass index -- obesity -- childhood acute lymphoblastic leukaemia -- adverse events -- toxicity; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; 616.15
• DOI: 10.1111/bjh.17936
• Languages: English
• ISSNs: 0007-1048

Abstract

Summary: Obesity is associated with poor outcomes in childhood acute lymphoblastic leukaemia (ALL). We explored whether severe treatment‐related toxicity and treatment delays could explain this observation. This study included 1 443 children aged 2·0–17·9 years with ALL treated with the Nordic Society of Pediatric Haematology and Oncology (NOPHO) ALL2008 non‐high‐risk protocol. Prospective treatment‐related toxicities registered every three‐month interval were used. Patients were classified according to sex‐ and age‐adjusted international childhood cut‐off values, corresponding to adult body mass index: underweight, <17 kg/m 2 ; healthy weight, 17 to <25 kg/m 2 ; overweight, 25 to <30 kg/m 2 ; and obese, ≥30 kg/m 2 . Obese children had a higher incidence rate ratio (IRR) for severe toxic events {IRR: 1·55 [95% confidence interval (CI) 1·07–2·50]}, liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy‐weight children. Obese children aged ≥10 years had increased IRRs for asparaginase‐related toxicities compared with healthy‐weight older children: thromboses [IRR 2·87 (95% CI 1·00–8·21)] and anaphylactic reactions [IRR 7·95 (95% CI 2·15–29·37)] as well as higher risk for truncation of asparaginase [IRR 3·54 (95% CI 1·67–7·50)]. The high prevalence of toxicity and a higher risk of truncation of asparaginase may play a role in the poor prognosis of obese children aged ≥10 years with ALL.