A Review on the Impact of Body Mass Index on Outcomes in Pediatric Leukemia

Figures & data

Table 1 ALL and BMI

References	n	ALL Subtype	Chemotherapy Regimens	BMI Groups Definition	Age Range, Y	Outcomes
Nunez-Enriquez JC, BMC Cancer 2019^Citation24	1070	B cell= 931	Not mentioned	WHO	0–15	Overweight and obese had higher early mortality
		Biphenotypic= 37		CDC
		T cell= 102
Martín-Trejo JA, Leuk Lymph 2017^Citation23	794	B cell =706	Not mentioned	WHO	0−17	High risk of dying in malnourished children with a high-risk ALL
		T cell=88		CDC
Eissa HM, Blood Cancer J 2017^Citation21	373	B cell=310	Total XV protocol	CDC	2–17.9	No differences in relapse incidence and EFS
		T cell=63				Obese had worse OS
Niinimaki RA, JCO 2007^Citation16	97	All B cell precursor	ALL-NSPHO 86, 92, 2000	Finnish norms	1–15	High BMI associated with radiographic osteonecrosis
den Hoed MAH, Haematologica 2015^Citation20	703	B cell=573	DCOG - ALL19	WHO	2–17	Higher relapse risk in underweight, but similar OS and EFS
		T cell=130
Hijiya N, Blood 2006^Citation14	621	B cell=516	Total XII, XIIIA, XIIIB, XIV	CDC	1.01–18.08	EFS, OS relapse incidence and toxicities did not differ among the 4 BMI groups
		T cell=105
Butturini AM, JCO 2007^Citation9	4260	B cell= 473*	CCG-1922, 1891, 1882, 1901	CDC	2–19.99	Higher EFS and relapse incidence in ≥10 years
		T cell=136
		Other= 77
Gelelete CB, Obesity, 2011^Citation17	181	B cell=144	BMF90, BFM95, BFM2002	WHO	≤10–18	5-y EFS lower in overweight/obese
		T cell= 36
Yazbeck N, J Pediatr Oncol 2016^Citation22	103	B and T cell	Not mentioned	WHO	0−17	Trend showing worse outcomes in malnourished children (death and relapse)
				CDC
Orgel E, Blood 2014^Citation18	198	All B cell precursor	CCG-1991, 1961; AALL0331, 0932, 08P1, 0232, 1131	CDC	1 21	Obesity at induction associated with greater risk of persistent MRD
				WFL≤ 1 y
Baillargeon J, J Pediatr Oncol 2006^Citation15	322	B cell	Not mentioned	WHO	0–18	Obesity not associated with decreased OS or EFS
				CDC
Aldhafiri FK, J Pediatr Hematol Oncol 2014^Citation19	1033	All B cell precursor	UK ALL-X	BMI according international survey thresholds	2–14.9	Relapse incidence was no different among the 4 groups

Note: *Data available for pts ≥10 years.

Abbreviations: BMI, body mass index; WHO, World Health Organisation; CDC, Centers of Disease Control; ALL, acute lymphoblastic leukemia; NSPHO, Nordic Society of Pediatric Hematology and Oncology; OS, overall survival; EFS, event-free survival; DCOG, Dutch Childhood Oncology Group; CCG, Children's Cancer Group; WFL, weight-for-length; MRD, minimal residual disease.

Table 2 AML and BMI

References	n	Chemotherapy Regimens	BMI Groups Definition	Age Range, Y	Outcomes
Lohmann DJ, Haematologica 2016^Citation35	318	NOPHO-AML 2004	WHO	0–17	Overweight associated with requirement in supplemental oxygen
					Overweight and aged 10–17 higher risk of grade 3–4 toxicity
Chen SH, Int J Hematol 2015^Citation34	58	TPOG-AML-97	WHO	0–18	5-y EFS was not significantly different among BMI groups
Canner J, Cancer 2013^Citation33	1840	CCG-2891, 2941, 2961, AAML03P1	WFL≤ 1 y	0.01–20.9	Overweight had higher risk for TRM, EFS and OS
			CDC
Inaba H, Cancer 2012^Citation32	314	AML87, 91, 9, 02	CDC	2–19.9	Lower 5-y OS in children overweight and obese
					Higher TRT in underweight
Lange BJ, JAMA 2005^Citation8	768	CCG-2961	CDC	0.01–20.9	Lower 3-y OS and EFS in obese
Lohmann DJ, Cancer Med 2019^Citation36	867	AAML0531,15; COG9421,16; NOPHO‐AML 2004,17 DB AML‐01,18; NOPHO‐DBH AML 2012	WHO		No difference in relapse risk, TRM, 5-year OS across the BMI groups
					Obese patients had a higher frequency of t(8;21) and inv(16)

Abbreviations: BMI, body mass index; WHO, World Health Organization; CDC, Centers of Disease Control; NOPHO, Nordic Society for Pediatric Hematology and Oncology; OS, overall survival; EFS, event-free survival; DCOG, Dutch Childhood Oncology Group; CCG, Children’s Cancer Group; WFL, weight-for-length; TPOG, Taiwan Pediatric Oncology protocol.

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