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. 2022 Mar;196(5):1239-1247.
doi: 10.1111/bjh.17936. Epub 2021 Nov 2.

Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia

Christina Egnell  1   2 , Mats Heyman  2 , Ólafur Gisli Jónsson  3 , Raheel A Raja  4   5 , Riitta Niinimäki  6 , Birgitte Klug Albertsen  7   8 , Kjeld Schmiegelow  4   5 , Niklas Stabell  9 , Goda Vaitkeviciene  10 , Kristi Lepik  11 , Arja Harila-Saari  12 , Susanna Ranta  1   2
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Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia

Christina Egnell et al. Br J Haematol. 2022 Mar.

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Br J Haematol. 2022 Aug;198(3):610. doi: 10.1111/bjh.18310. Br J Haematol. 2022. PMID: 35877468 No abstract available.

Abstract

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/m2 ; healthy weight, 17 to <25 kg/m2 ; overweight, 25 to <30 kg/m2 ; and obese, ≥30 kg/m2 . 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.

Keywords: adverse events; body mass index; childhood acute lymphoblastic leukaemia; obesity; toxicity.

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References

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