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Meta-Analysis
. 2015 Aug;62(8):1452-60.
doi: 10.1002/pbc.25519. Epub 2015 Mar 24.

Growth patterns during and after treatment in patients with pediatric ALL: A meta-analysis

Fang Fang Zhang  1   2 , Shanshan Liu  1 , Mei Chung  3 , Michael J Kelly  4   5
Affiliations
Meta-Analysis

Growth patterns during and after treatment in patients with pediatric ALL: A meta-analysis

Fang Fang Zhang et al. Pediatr Blood Cancer. 2015 Aug.

Abstract

Background: Survivors of pediatric acute lymphoblastic leukemia (ALL) have a significantly higher body mass index (BMI) than their peers. Understanding the critical time periods in which patients with pediatric ALL are vulnerable to unhealthy weight gain will lay the groundwork for developing effectively timed interventions.

Procedure: We determined the growth patterns of patients with pediatric ALL during and after treatment through the conduct of a systematic review and meta-analysis. A search of MEDLINE, Scopus, and Web of Science was performed from its inception through May 2014. Studies met the inclusion criteria if they included at least 10 patients of pediatric ALL, and longitudinally assessed BMI at diagnosis and at least one time point after diagnosis

Results: Twenty-one studies met the inclusion criteria for the systematic review and 16 were included in meta-analysis. The mean increase in BMI z-score during treatment in 1,514 patients with pediatric ALL was 0.81 (95% CI: 0.25-1.38). Specifically, patients experienced substantial weight gain in early treatment (Δ = 0.41, 95% CI: -0.34, 1.17) and again during maintenance (Δ = 0.34, 95% CI:-0.22, 0.90). The mean increase in BMI z-score ranged between 0.52 and 0.89 beyond treatment completion. Subgroup analyses found unhealthy weight gain occurred regardless of patients' receipt of cranial radiation therapy, sex, and, weight status at diagnosis.

Conclusions: Patients with pediatric ALL experience unhealthy weight gain early in treatment, and increases in weight are maintained beyond treatment completion. Preventing early onset of obesity is a priority for improving the care and outcomes for patients with pediatric ALL.

Keywords: acute lymphoblastic leukemia; growth; obesity; pediatric; survivors.

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Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Study Flow Chart
Figure 2
Figure 2. Changes in BMI z-score during and after treatment in patients with pediatric ALL
Δ (95% confidence interval) represents pooled random-effects meta-analysis results for the mean change in BMI z-score since diagnosis at each time period during and after treatment. I2 quantifies the extent of heterogeneity across studies. n represents the number of studies included in each meta-analysis.
Figure 3
Figure 3. Changes in BMI z-score during and after treatment in patients with pediatric ALL by patient and treatment characteristics
A. Changes in BMI z-score by receipt of cranial radiation therapy (CRT). B. Changes in BMI z-score by sex. C. Changes in BMI z-score by weight status at diagnosis.
See this image and copyright information in PMC

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