Weight at diagnosis and during treatment

Three studies did not demonstrate an independent effect of obesity on EFS.[98][Level of evidence B4]; [99,100][Level of evidence C2]

Two studies showed obesity to be an independent prognostic factor only in patients older than 10 years or in patients with intermediate-risk or high-risk disease.[101,102][Level of evidence C2]

The COG reported on the impact of obesity on outcome in 2,008 children, 14% of whom were obese, who were enrolled on a high-risk ALL trial (CCG-1961 [NCT00002812]).[103][Level of evidence B4] Obesity was found to be an independent variable for inferior outcome compared with nonobese patients (5-year EFS rates, 64% vs. 74%; P = .002). However, obese patients at diagnosis who then lost weight during the premaintenance period of treatment had outcomes similar to patients with normal weight at diagnosis.

In a retrospective study of patients treated at a single institution, obesity at diagnosis was linked to an increased risk of having MRD at the end of induction and an inferior EFS.[104][Level of evidence C2]

In a different retrospective study of 373 patients treated at a single institution, body mass index (BMI) at diagnosis was not associated with MRD at days 19 and 46, cumulative incidence of relapse, or EFS. OS was lower in patients with a high BMI, primarily resulting from treatment-related mortality and inferior salvage after relapse.[105][Level of evidence C1]

In one study, obesity at diagnosis was associated with increased toxicity and truncated administration of asparaginase, especially in older children and adolescents.[106]

In a study of 388 patients aged 15 to 50 years who were treated with Dana-Farber Cancer Institute (DFCI) ALL consortium regimens, greater BMI was associated with higher rates of relapse and nonrelapse mortality, as well as inferior OS. Higher BMI was associated with increased rates of hepatotoxicity and hyperglycemia. The deleterious effect of elevated BMI was more pronounced in older patients. Among patients aged 15 to 29 years at diagnosis (n = 254), the 4-year OS rate was 73% for those with high BMI, compared with 83% for those with BMI in the reference range (P = .09).[107]