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Obesity as a predictor of treatment‐related toxicity in children with acute lymphoblastic leukaemia
Author(s) -
Egnell Christina,
Heyman Mats,
Jónsson Ólafur Gisli,
Raja Raheel A.,
Niinimäki Riitta,
Albertsen Birgitte Klug,
Schmiegelow Kjeld,
Stabell Niklas,
Vaitkeviciene Goda,
Lepik Kristi,
HarilaSaari Arja,
Ranta Susanna
Publication year - 2022
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.17936
Subject(s) - medicine , underweight , pediatrics , body mass index , confidence interval , overweight , incidence (geometry) , obesity , rate ratio , physics , optics
Summary 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/m 2 ; healthy weight, 17 to <25 kg/m 2 ; overweight, 25 to <30 kg/m 2 ; and obese, ≥30 kg/m 2 . 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.