Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia

• Published in: Blood Vol. 124; no. 26; pp. 3932 - 3938
• Main Authors: Orgel, Etan, Tucci, Jonathan, Alhushki, Waseem, Malvar, Jemily, Sposto, Richard, Fu, Cecilia H., Freyer, David R., Abdel-Azim, Hisham, Mittelman, Steven D.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 18-12-2014
• Subjects: Adolescent; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Body Mass Index; Body Weight; Bone Marrow - pathology; Child; Child, Preschool; Cohort Studies; Disease-Free Survival; Female; Flow Cytometry; Humans; In Situ Hybridization, Fluorescence; Infant; Leukemia - complications; Leukemia - mortality; Male; Neoplasm, Residual - diagnosis; Obesity - complications; Overweight; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma - therapy; Prognosis; Proportional Hazards Models
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2014-08-595389

Obesity is associated with poorer event-free survival (EFS) in pediatric acute lymphoblastic leukemia (ALL). Persistent minimal residual disease (MRD) in the bone marrow as measured by multidimensional flow cytometry (MDF) is a key early prognostic indicator and is strongly associated with EFS. We therefore hypothesized that obesity during induction would be associated with positive end-of-induction MRD (≥0.01%). We analyzed MDF of end-induction bone marrow samples from a historical cohort of 198 children newly diagnosed with B-precursor ALL (BP-ALL) and treated with Children’s Oncology Group induction regimens. We assessed the influence of body mass index on risk for positive end-induction MRD in the bone marrow. In our cohort of BP-ALL, 30 children (15.2%) were overweight and 41 (20.7%) were obese at diagnosis. Independent of established predictors of treatment response, obesity during induction was associated with significantly greater risk for persistent MRD (odds ratio, 2.57; 95% confidence interval, 1.19 to 5.54; P = .016). Obesity and overweight were associated with poorer EFS irrespective of end-induction MRD (P = .012). Obese children with newly diagnosed BP-ALL are at increased risk for positive end-induction MRD and poorer EFS.
•Obesity is associated with increased risk for persistent minimal residual disease after induction therapy for pediatric BP-ALL.