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

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DOI

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  • Christina Egnell
  • Mats Heyman
  • Ólafur Gisli Jónsson
  • Raheel A Raja
  • Riitta Niinimäki
  • Birgitte Klug Albertsen
  • Kjeld Schmiegelow
  • Niklas Stabell
  • Goda Vaitkeviciene
  • Kristi Lepik
  • Arja Harila-Saari
  • Susanna Ranta
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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.

Original languageEnglish
JournalBritish Journal of Haematology
Volume196
Issue number5
Pages (from-to)1239-1247
Number of pages9
ISSN0007-1048
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

© 2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.

    Research areas

  • Adolescent, Antineoplastic Agents/adverse effects, Asparaginase/adverse effects, Body Mass Index, Child, Child, Preschool, Female, Humans, Male, Pediatric Obesity/complications, Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications, Prospective Studies

ID: 78111525