Association of body mass index and survival in pediatric leukemia: a meta-analysis

Abstract

Background: Obesity is a worldwide epidemic in children and adolescents. Adult cohort studies have reported an association between higher body mass index (BMI) and increased leukemia-related mortality; whether a similar effect exists in childhood leukemia remains controversial.

Objective: We conducted a meta-analysis to determine whether a higher BMI at diagnosis of pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) is associated with worse event-free survival (EFS), overall survival (OS), and cumulative incidence of relapse (CIR).

Design: We searched 4 electronic databases from inception through March 2015 without language restriction and included studies in pediatric ALL or AML (0-21 y of age) reporting BMI as a predictor of survival or relapse. Higher BMI, defined as obese (≥95%) or overweight/obese (≥85%), was compared with lower BMI [nonoverweight/obese (<85%)]. Summary risk estimates for EFS, OS, and CIR (ALL only) were calculated with random- or fixed-effects models according to tests for between-study heterogeneity.

Results: Of 4690 reports identified, 107 full-text articles were evaluated, with 2 additional articles identified via review of citations; 11 articles were eligible for inclusion in this meta-analysis. In ALL, we observed poorer EFS in children with a higher BMI (RR: 1.35; 95% CI: 1.20, 1.51) than in those at a lower BMI. A higher BMI was associated with significantly increased mortality (RR: 1.31; 95% CI: 1.09, 1.58) and a statistically nonsignificant trend toward greater risk of relapse (RR: 1.17; 95% CI: 0.99, 1.38) compared with a lower BMI. In AML, a higher BMI was significantly associated with poorer EFS and OS (RR: 1.36; 95% CI: 1.16, 1.60 and RR: 1.56; 95% CI: 1.32, 1.86, respectively) than was a lower BMI.

Conclusion: Higher BMI at diagnosis is associated with poorer survival in children with pediatric ALL or AML.

Keywords: nutritional status; obesity; pediatric leukemia; relapse; survival.

FIGURE 1

Results of search strategy. ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia.

FIGURE 2

Meta-analyses of event-free survival and overall survival according to BMI in childhood acute lymphoblastic leukemia are depicted. The studies are ordered according to year of study publication, with the black-filled diamonds representing the study-specific RRs and the horizontal line representing the 95% CI with the use of fixed-effects models. The open diamonds correspond to summary RRs.

FIGURE 3

Meta-analyses of event-free survival and overall survival according to BMI in childhood acute lymphoblastic leukemia for those ≥10 y of age. The studies are ordered according to year of study publication, with the black-filled diamonds representing the study-specific RRs and the horizontal line representing the 95% CI with the use of fixed-effects models. The open diamonds correspond to summary RRs.

FIGURE 4

Meta-analyses of event-free survival and overall survival according to BMI in childhood acute myeloid leukemia are depicted. The studies are ordered according to year of study publication, with the black-filled diamonds representing the study-specific RRs and the horizontal line representing the 95% CI with the use of fixed-effects models. The open diamonds correspond to summary RRs.