Impact of BMI on Treatment Outcomes for Adolescent and Young Adult Patients With ALL

By Cailin Conner - July 31, 2023

Acute lymphoblastic leukemia (ALL) is a type of blood cancer that commonly affects adolescents and young adults (AYAs). While advancements in treatment regimens have improved survival rates, recent research suggests that body weight may play a significant role in treatment outcomes. A study conducted on AYAs treated with asparaginase-containing pediatric regimens aimed to investigate the association between body mass index (BMI) and various clinical outcomes, including overall survival (OS) and toxicity. The results were published in Blood Advances.

The study included 388 AYAs aged 15 to 50 years who were treated between 2008 and 2021. A total of 46.7% of the patients were classified as overweight or obese based on their BMI, while 53.3% had a normal BMI. Notably, patients who were overweight or obese experienced higher nonrelapse mortality (NRM), worse event-free survival, and worse OS compared with those with a normal BMI.

Furthermore, when the analysis was stratified by age, younger AYAs (15-29 years) had a normal BMI more frequently compared with older AYAs (30-50 years). Younger and older AYAs with a normal BMI showed excellent OS rates, indicating that BMI did not significantly impact outcomes in this group. Conversely, AYAs who were overweight or obese had worse outcomes, particularly among patients in the older age group.

The study also evaluated the association between BMI and treatment-related toxicity. AYAs with an overweight or obese BMI experienced higher rates of grade 3 and 4 hepatotoxicity and hyperglycemia. However, the rates of hypertriglyceridemia were comparable between the 2 BMI groups. These findings suggest that elevated BMI in AYAs with ALL may contribute to increased treatment toxicity, thereby negatively impacting survival rates.

In a multivariable analysis, the researchers identified several factors associated with treatment outcomes. Higher BMI was independently associated with worse OS, indicating that body weight plays a crucial role in the effectiveness of ALL treatment. Interestingly, hypertriglyceridemia was associated with improved OS, highlighting a potential protective effect. Age did not appear to significantly influence OS rates.

“Elevated BMI is associated with increased toxicity, NRM, and decreased OS among AYAs treated on [Dana-Farber Cancer Institute] Consortium pediatric ALL regimens,” the authors of the study wrote regarding the key takeaways of their research. “Normal BMI is associated with excellent outcomes regardless of age. The deleterious effect of increased BMI is more pronounced in older AYAs.”

Source: Blood Advances


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