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Changes in body mass index in long‐term survivors of childhood acute lymphoblastic leukemia treated without cranial radiation and with reduced glucocorticoid therapy
Author(s) -
Touyz Lauren M.,
Cohen Jennifer,
Neville Kristen A.,
Wakefield Claire E.,
Garnett Sarah P.,
Mallitt KylieAnn,
Grech Allison M.,
Cohn Richard J.
Publication year - 2017
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26344
Subject(s) - medicine , body mass index , anthropometry , dexamethasone , pediatrics , glucocorticoid , longitudinal study , radiation therapy , pathology
Background Cranial radiation and glucocorticoids are associated with an increase in body mass index (BMI) z‐score in survivors of childhood acute lymphoblastic leukemia (ALL). We aimed to investigate the impact of a contemporary treatment protocol that omitted prophylactic cranial radiation and glucocorticoids from the maintenance phase on longitudinal BMI, height, and weight z‐scores in children with ALL. Method We retrospectively studied 184 children with standard‐ and medium‐risk ALL treated without cranial radiation or glucocorticoids. Height, weight, and BMI z‐scores were collected from diagnosis to 7 years after diagnosis. Longitudinal changes in anthropometric data were compared to diagnosis using separate linear mixed models, adjusting for age, sex, and socioeconomic status (SES). Results Relative to diagnosis, there was a significant increase in estimated marginal mean BMI z‐score during dexamethasone‐containing re‐induction (1.08, P < 0.001) that persisted throughout intensification (0.85, P < 0.001) and maintenance phases (0.81, P < 0.001), and up to 7 years after diagnosis (0.76, P = 0.002). Height z‐scores decreased over the same time ( P < 0.001), whereas weight z‐scores fluctuated during treatment and declined thereafter ( P = 0.007). A higher BMI z‐score at diagnosis was associated with a younger age ( P < 0.001), male sex ( P < 0.001), and lower SES ( P < 0.001). Conclusions Children who did not receive cranial radiation or glucocorticoids during maintenance remain at increased risk of treatment‐related increases in BMI z‐score, which is associated with a loss of height z‐score. Interventions designed to mediate this risk should begin early, even while children are on treatment because of the association with cardiovascular risk. Monitoring of survivors of ALL should include anthropometric measures.