Impact of body mass index on outcome and treatment-related toxicity in young adults with acute lymphoblastic leukemia

Authors

  • Christina Egnell a Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; b Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
  • Helene Hallböök c Department of Medical Sciences, Haematology, Uppsala University, Uppsala, Sweden
  • Mats Heyman a Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; b Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
  • Ulla Wartiovaara-Kautto d HUS Comprehensive Cancer Center, Helsinki University Area Hospitals, Helsinki, Finland
  • Petter Quist-Paulsen e Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
  • Kjeld Schmiegelow f Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
  • Laimonas Griskevicius g Hematology, Oncology and Transfusion Medicine Center, Vilnius, Lithuania
  • Katrin Palk h Haematology Centre, North Estonia Medical Centre, Tallinn, Estonia
  • Nina Toft i Department of Haematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  • Ulrik Malthe Overgaard i Department of Haematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  • Arja Harila j Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
  • Susanna Ranta a Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden;b Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

DOI:

https://doi.org/10.1080/0284186X.2023.2258450

Keywords:

Obesity, acute lymphoblastic leukemia, toxicity, young adults, body mass index

Abstract

Background

Data on outcome for patients in different body mass index (BMI) categories in young adults with acute lymphoblastic leukemia (ALL) are scarce. We explored survival and toxicities in different BMI categories in young adults with ALL.

Material and methods

Patients aged 18–45 years, diagnosed with ALL between July 2008 and June 2022 in the Nordic countries, Estonia, or Lithuania, and treated according to the NOPHO ALL2008 protocol, were retrospectively enrolled and classified into different BMI categories. Endpoints were overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse as well as incidence rate ratio (IRR) of severe predefined toxic events, and treatment delays.

Results

The group comprised 416 patients, of whom 234 (56%) were stratified to non-high-risk (non-HR) treatment. In the non-HR group, patients with severe obesity, BMI ≥35 kg/m2 had worse EFS due to relapses but there was no effect on toxicity or treatment delays compared with the healthy-weight patients. There was no association between BMI category and OS, overall toxicity, or treatment delays in the patients with high-risk treatment.

Conclusion

Severe obesity is associated with worse EFS in young adults treated according to the non-HR arms of the NOPHO ALL2008 protocol. Poorer outcome is explained with a higher risk of relapse, possibly due to under treatment, and not caused by excess therapy-related mortality.

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Published

2023-12-02

How to Cite

Egnell, C., Hallböök, H., Heyman, M., Wartiovaara-Kautto, U., Quist-Paulsen, P., Schmiegelow, K., … Ranta, S. (2023). Impact of body mass index on outcome and treatment-related toxicity in young adults with acute lymphoblastic leukemia. Acta Oncologica, 62(12), 1723–1731. https://doi.org/10.1080/0284186X.2023.2258450

Issue

Vol. 62 No. 12 (2023): Acta Oncologica

Section

Articles