Overweight, obesity linked to adverse outcomes among AYAs treated for leukemia
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Key takeaways:
- Elevated BMI also appeared associated with increased toxicity among AYAs treated with pediatric ALL regimens.
- Researchers found no association between BMI and age at the time of treatment.
Adolescents and young adults with overweight or obesity had poorer clinical outcomes than their normal-weight counterparts after receiving a pediatric regimen for treatment of acute lymphoblastic leukemia, study results showed.
The findings — published in Blood Advances — also revealed that age at time of treatment had no impact on OS outcomes when comparing adolescents and young adults with overweight or obesity vs. normal BMI.
“Obesity is a prevalent and growing health challenge worldwide,” Marlise R. Luskin MD, MSCE, assistant professor of medicine at Harvard Medical School and senior physician at Dana-Farber Cancer Institute, and Shai Shimony, MD, advanced leukemia fellow at Dana-Farber, told Healio in a joint statement. “We hope that this research will prompt investigators to include multiple measures of obesity into prospective trials of novel ALL treatment approaches so that more can be learned about the optimal treatment of individuals with higher BMI.”
Background
Previous research illustrated an association between poorer outcomes and obesity in children treated for ALL, according to Luskin and Shimony.
“It has been recognized now for several years that ALL regimens developed by our colleagues in pediatric oncology are able cure the majority of children with ALL and that extending these regimens to adolescents and young adults can improve outcomes,” they told Healio. “The goal for this research was to further understand which adolescents and young adults specifically benefit from this ‘pediatric approach,’ and which patients do not ... so that further research can be focused on improving outcomes for those patients.”
Methodology
Shimony and colleagues conducted a multicenter retrospective analysis to identify any association between BMI and treatment outcomes among adolescents and young adults (AYAs) treated with a Dana-Farber Cancer Institute ALL Consortium protocol between 2008 and 2011.
The study included 388 patients aged 15 to 50 years (median age, 24 years; range, 1-50; 62% male). Among them, 207 (53.3%) had a normal BMI and 181 (46.6%) had an overweight/obese BMI.
Younger AYAs aged 15 to 29 years comprised 65% of the study group, compared with 35% categorized as older AYAs (aged 30-50 years).
Key findings
Among AYAs with an overweight/obese BMI, researchers reported significantly higher 4-year nonrelapse mortality (11.7% vs. 2.8%; P = .006) and worse 4-year EFS (63% vs. 77%; P = .003) and OS (64% vs. 83%; P = .0001) than those who had a normal BMI.
A toxicity analysis showed significantly higher rates of grade 3 to grade 4 hepatotoxicity (60.7% vs. 42.2%; P = .0005) and hyperglycemia (36.4% vs. 24.4%; P = .014) among AYAs with an overweight/obese BMI compared with those who had a normal BMI.
A separate analysis evaluating younger vs. older AYAs with normal BMI found comparable 4-year OS (83% vs. 85%) between the groups.
Meanwhile, investigators found that older AYAs with an overweight/obese BMI had significantly worse 4-year OS rates than younger AYAs with an overweight/obese BMI (55% vs. 73%; P = .023).
Clinical implications
Clinicians treating young adults with higher BMI should monitor these patients very closely for response and adverse events, Luskin and Shimony told Healio.
“We recommend these patients be enrolled in clinical trials whenever possible so that more can be learned about how this group of patients respond to novel treatment approaches,” they wrote.
For more information:
Marlise R. Luskin, MD, MSCE, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: marlise_luskin@dfci.harvard.edu.
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