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Dong L, Dai G, Zhao J. Impact of body mass index at diagnosis on outcomes of pediatric acute leukemia: A systematic review and meta-analysis. PLoS One 2024; 19:e0302879. [PMID: 38709714 PMCID: PMC11073705 DOI: 10.1371/journal.pone.0302879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/14/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The incidence of childhood malnutrition i.e., both obesity and undernutrition, is on a rise. While there is extensive evidence of the influence of body mass index (BMI) on the survival and other important outcomes of adult cancers, the impact of childhood BMI on one of the common pediatric cancers i.e., leukemia is not well studied. METHODS Systematic search of PubMed, Scopus, and Google Scholar databases was done to identify studies that were conducted among pediatric patients with leukemia and had examined outcomes of interest based on BMI at the time of diagnosis. RESULTS Effect sizes were reported as pooled hazards ratio (HR) along with 95% confidence intervals (CI). A total of 17 studies were included. Compared to pediatric leukemia patients with normal BMI, underweight (HR 1.07, 95% CI: 1.04, 1.11) and obese (HR 1.42, 95% CI: 1.18, 1.71) children with leukemia had higher risks of overall mortality. Underweight (HR 1.10, 95% CI: 1.02, 1.19) and obese (HR 1.34, 95% CI: 1.15, 1.55) pediatric leukemia patients had a tendency to lower event-free survival compared to children with normal BMI. The risk of relapse was not significant for underweight, overweight, and obese children. CONCLUSIONS Both underweight and obese status at the time of diagnosis were associated with poor survival outcomes in pediatric patients with leukemia.
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Affiliation(s)
- Ling Dong
- Department of Pediatrics, Changxing People’s Hospital, Huzhou City, Zhejiang Province, China
| | - Guixing Dai
- Department of Pediatrics, Changxing People’s Hospital, Huzhou City, Zhejiang Province, China
| | - Jing Zhao
- Department of Pediatrics, Changxing People’s Hospital, Huzhou City, Zhejiang Province, China
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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Alves C, Pereira J, Rego EM, Rocha V, Silva WF. Outpatient administration of high-dose methotrexate in adults without drug monitoring - a case-control study of risk factors for acute kidney injury. Hematol Transfus Cell Ther 2023:S2531-1379(23)02599-3. [PMID: 38233304 DOI: 10.1016/j.htct.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/21/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION High-dose methotrexate (HDMTX) is an essential part of chemotherapy regimens for hematologic neoplasms. The incidence of acute kidney injury (AKI) after HDMTX in unmonitored outpatient infusion had not been reported in adults yet. In this study, we evaluated toxicity data after outpatient administration of HDMTX without drug monitoring. METHODS Patients 16 years old or over with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received at least one outpatient infusion of HDMTX without drug level monitoring were included. This is a retrospective, nested case-control study, in which the cases comprised patients who developed AKI after HDMTX. RESULTS Overall, 302 patients were included, encompassing 840 infusions. Hospitalization occurred in 8.6 %. A total of 25 patients presented AKI after HDMTX administration, corresponding to 3 % of the methotrexate (MTX) infusions and 8.3 % of the patients. HIV-associated Burkitt lymphoma was more common in patients who presented AKI (18 vs. 6.8 %, p = 0.03). Baseline factors related to AKI after HDMTX were age > 44 y, body surface area ≥ 1.76 m2, body mass index (BMI) ≥ 23.8 kg/m2, glomerular filtration rate, and thrombocytopenia (< 150×109/L). Multivariable analysis for adjusting such factors found that BMI was independently related to AKI after HDMTX (OR 3.8). Death after AKI occurred in 56 %. CONCLUSION Our data showed a similar rate of AKI after HDMTX to that reported in the literature, even without drug monitoring. However, patients who developed AKI in our cohort fared worse than expected, with more hospitalizations and death. A higher BMI was associated with the MTX-induced AKI in our cohort, suggesting a differential drug clearance and the need for specific guidelines for obese patients.
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Affiliation(s)
- Camila Alves
- Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil
| | - Juliana Pereira
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil
| | - Eduardo M Rego
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil
| | - Vanderson Rocha
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil
| | - Wellington F Silva
- Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Division of Hematology and Cell Therapy, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil.
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Egnell C, Hallböök H, Heyman M, Wartiovaara-Kautto U, Quist-Paulsen P, Schmiegelow K, Griskevicius L, Palk K, Toft N, Overgaard UM, Harila A, Ranta S. Impact of body mass index on outcome and treatment-related toxicity in young adults with acute lymphoblastic leukemia. Acta Oncol 2023; 62:1723-1731. [PMID: 37725524 DOI: 10.1080/0284186x.2023.2258450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Data on outcome for patients in different body mass index (BMI) categories in young adults with acute lymphoblastic leukemia (ALL) are scarce. We explored survival and toxicities in different BMI categories in young adults with ALL. MATERIAL AND METHODS Patients aged 18-45 years, diagnosed with ALL between July 2008 and June 2022 in the Nordic countries, Estonia, or Lithuania, and treated according to the NOPHO ALL2008 protocol, were retrospectively enrolled and classified into different BMI categories. Endpoints were overall survival (OS), event-free survival (EFS) and cumulative incidence of relapse as well as incidence rate ratio (IRR) of severe predefined toxic events, and treatment delays. RESULTS The group comprised 416 patients, of whom 234 (56%) were stratified to non-high-risk (non-HR) treatment. In the non-HR group, patients with severe obesity, BMI ≥35 kg/m2 had worse EFS due to relapses but there was no effect on toxicity or treatment delays compared with the healthy-weight patients. There was no association between BMI category and OS, overall toxicity, or treatment delays in the patients with high-risk treatment. CONCLUSION Severe obesity is associated with worse EFS in young adults treated according to the non-HR arms of the NOPHO ALL2008 protocol. Poorer outcome is explained with a higher risk of relapse, possibly due to under treatment, and not caused by excess therapy-related mortality.
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Affiliation(s)
- Christina Egnell
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Helene Hallböök
- Department of Medical Sciences, Haematology, Uppsala University, Uppsala, Sweden
| | - Mats Heyman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Petter Quist-Paulsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Katrin Palk
- Haematology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Nina Toft
- Department of Haematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ulrik Malthe Overgaard
- Department of Haematology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Arja Harila
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susanna Ranta
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Coe-Eisenberg TD, Perissinotti AJ, Marini BL, Pettit KM, Bixby DL, Burke PW, Benitez L. Evaluating the efficacy and toxicity of dose adjusted pegylated L-asparaginase in combination with therapeutic drug monitoring. Ann Hematol 2023; 102:3133-3141. [PMID: 37480389 DOI: 10.1007/s00277-023-05373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
The incorporation of pediatric-inspired regimens in the adolescent-young-adult (AYA) and adult populations have resulted improved survival outcomes (Stock et al. Blood 133(14):1548-1559 2019; Dunsmore et al. J Clin Oncol 38(28):3282-3293 2020; DeAngelo et al. Leukemia 29(3):526-534 2015). Nonetheless incorporation of such regimens is limited by increased toxicity to asparaginase. Dosing strategies that reduce the weight-based dose of pegylated-L-asparaginase (PEG-asparaginase) utilizing activity monitoring have been shown to result in better tolerability of these regimens. The purpose of this study was to analyze the efficacy and safety of treating adults with Philadelphia chromosome negative (Ph-) ALL with pediatric-inspired regimens that incorporate PEG-asparaginase dose adjustments and asparaginase activity level monitoring. Patients aged 18-65 years initiated on pediatric-inspired regimens utilizing dose-reduced PEG-asparaginase with therapeutic drug monitoring-guided adjustments were included. The screening of 122 patients treated between 2015 and 2021 resulted in the inclusion of 54 patients. The median age of the cohort was 35 years (16-65 years), and median body mass index (BMI) was 30 kg/m2 (18.3-53.4 kg/m2). The 36-month survival estimate was 62.1% (95% CI 48.1-77.7%), and the median overall survival (OS) was 62.2 months (95% CI 35.1-89.3 months). In the AYA cohort, the 36-month survival was 71.2% (95% CI 55.8-91%) and the median overall survival was not reached. Survival was not significantly affected by immunophenotype or BMI. Discontinuation due to toxicity or hypersensitivity reactions was low at 11% and 9% respectively. The encouraging survival outcomes and favorable tolerability of this older population in the real-world setting support the use of individualized PEG-asparaginase dosing with PharmD-guided therapeutic drug monitoring.
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Affiliation(s)
| | | | - Bernard L Marini
- Michigan Medicine, Ann Arbor, MI, USA
- Department of Pharmacy Services Michigan Medicine, University of Michigan College of Pharmacy, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
| | | | | | | | - Lydia Benitez
- Michigan Medicine, Ann Arbor, MI, USA.
- Department of Pharmacy Services Michigan Medicine, University of Michigan College of Pharmacy, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA.
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Gustaitė S, Everatt V, Kairienė I, Vaišnorė R, Rascon J, Vaitkevičienė GE. Changes in Nutritional Status during Induction Phase and Their Association with Fever and Minimal Residual Disease in Paediatric Acute Lymphoblastic Leukaemia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1008. [PMID: 37374212 DOI: 10.3390/medicina59061008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Background and objectives: Acute lymphoblastic leukaemia (ALL) is associated with a cytokine imbalance and oxidative stress, which can be aggravated by malnutrition. Malnutrition, defined by the World Health Organisation (WHO) as obesity or undernutrition, can affect treatment complications and outcomes. Therefore, we aimed to analyse the change in the body mass index (BMI) z-score during induction, as well as evaluate the impact of childhood malnutrition on fevers at an ALL presentation and early response to therapy. Methods: An observational cohort study of 50 consecutive children with ALL, diagnosed in 2019-2022, was performed. Patients were divided into age groups of 0-5, 6-11, and 12-17 years. BMI-for-age z-scores were used to define undernutrition and overnutrition according to WHO growth standards. Results: The number of patients with an abnormal BMI increased from 3 (6%) at diagnosis to 10 (20%) at the end of induction (from 2 (4%) to 6 (12%) in overweight/obese, and from 1 (2%) to 4 (8%) in underweight patients). At the end of induction, all overweight/obese patients were 0-5 years old. On the other hand, a statistically significant decrease in the mean BMI z-score among patients aged 12-17 was observed (p = 0.005). The mean BMI z-score differed statistically significantly among children aged 0-5 presenting with and without fever (p = 0.001). The minimal residual disease (MRD) level at the end of induction was not related to BMI at diagnosis. Conclusions: Despite the use of steroids, adolescents are prone to losing weight during an ALL induction, in contrast to preschool children, who tend to gain weight under the same treatment. BMI at diagnosis was related to a fever of ≥38 °C (at ALL presentation) in the 0-5 age group. The results emphasise the importance of careful nutritional status monitoring, with younger and older children as important target groups for weight gain and weight loss interventions, respectively.
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Affiliation(s)
- Sigita Gustaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Veronika Everatt
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Ignė Kairienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Ramunė Vaišnorė
- Reference Centre for Oncohaematological Diseases at the Haematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Jelena Rascon
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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Zobeck M, Bernhardt MB, Kamdar KY, Rabin KR, Lupo PJ, Scheurer ME. Novel and replicated clinical and genetic risk factors for toxicity from high-dose methotrexate in pediatric acute lymphoblastic leukemia. Pharmacotherapy 2023; 43:205-214. [PMID: 36764694 PMCID: PMC10085626 DOI: 10.1002/phar.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/12/2023]
Abstract
STUDY OBJECTIVE Methotrexate (MTX) is a key component of treatment for high-risk pediatric acute lymphoblastic leukemia (ALL) but may cause acute kidney injury and prolonged hospitalization due to delayed clearance. The purpose of this study is to identify clinical and genetic factors that may predict which children are at risk for creatinine increase and prolonged MTX clearance. DESIGN We conducted a single-center, retrospective cohort study of pediatric patients with ALL who received 4000-5000 mg/m2 of MTX. Measurements We performed germline genotyping to determine genetic ancestry and allele status for 49 single nucleotide polymorphisms (SNPs) identified from the literature as related to MTX disposition. Bayesian hierarchical ordinal regression models for creatinine increase and for prolonged MTX clearance were developed. MAIN RESULTS Hispanic ethnicity, body mass index (BMI) < 3%, BMI between 85%-95%, and Native American genetic ancestry were found to be associated with an increased risk for creatinine elevation. Older age, Black race, and use of the intensive monitoring protocol were associated with a decreased risk for creatinine elevation. Older age, B- compared to T-ALL, and the minor alleles of rs2838958/SLC19A1 and rs7317112/ABCC4 were associated with an increased risk for delayed clearance. Black race, MTX dose reduction, and the minor allele of rs2306283/SLCO1B1 were found to be associated with a decreased risk for delayed clearance. CONCLUSIONS These predictors of MTX toxicities may allow for more precise individualized toxicity risk prediction.
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Affiliation(s)
- Mark Zobeck
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - M. Brooke Bernhardt
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Kala Y. Kamdar
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Karen R. Rabin
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Philip J. Lupo
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
| | - Michael E. Scheurer
- Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas, USA
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Hu W, Cheung YT, Tang Y, Hong L, Zhu Y, Chen J, Wang Z, Zhou M, Gao Y, Chen J, Li B, Xue H, Gu L, Shen S, Tang J, Pui C, Inaba H, Cai J. Association between body mass index at diagnosis and outcomes in Chinese children with newly diagnosed acute lymphoblastic leukemia. Cancer Med 2023; 12:2850-2860. [PMID: 36168702 PMCID: PMC9939171 DOI: 10.1002/cam4.5188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Studies of the association between body mass index (BMI) at diagnosis and treatment outcome in children with acute lymphoblastic leukemia (ALL) have yielded inconsistent results. Hence, we conducted a retrospective study in a large cohort of Chinese children with ALL treated with contemporary protocols. PATIENTS AND METHODS A total of 1437 children (62.1% male; median age at diagnosis 5.7 years, range: 2.3-16.3 years) were enrolled in two consecutive clinical trials at the Shanghai Children's Medical Center. The rates of overall survival, event-free survival, relapse, treatment-related mortality, and adverse events were compared among patients who were underweight (BMI < 5th percentile), at a healthy weight (5th to 85th percentile), overweight (>85th to <95th percentile), and obese (≥95th percentile). RESULTS At diagnosis, 91 (6.3%) patients were underweight, 1070 (74.5%) were at a healthy weight, 91 (6.3%) were overweight, and 185 (12.9%) were obese. No significant association was found between weight status and 5-year overall survival, event-free survival, or relapse in the overall cohort. When analyzed as a continuous variable, a higher BMI Z-score was associated with treatment-related mortality (hazard ratio 1.33 (95% confidence interval [CI], 1.05-1.68%), p = 0.02). The treatment-related mortality rate was higher in the overweight (5.5%, 95% CI 0.8-10.2%) and obese (3.2%, 95% CI 0.6-5.8%) groups compared with the underweight (0.0%) and healthy-weight groups (1.9%, 95% CI 1.1-2.7%; p = 0.04). Multivariable analysis showed that children who were overweight had a higher risk of treatment-related mortality (hazard ratio 3.8, 95% CI 1.3-11.4). CONCLUSION While body weight status was not associated with event-free survival or overall survival, overweight patients were at higher risk of treatment-related mortality.
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Affiliation(s)
- Wenting Hu
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Yanjing Tang
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Li Hong
- Department of Clinical Nutrition, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuan Zhu
- Department of Clinical Nutrition, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jing Chen
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhuo Wang
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Min Zhou
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yijin Gao
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jing Chen
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Benshang Li
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huiliang Xue
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Longjun Gu
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuhong Shen
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jingyan Tang
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ching‐Hon Pui
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Hiroto Inaba
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jiaoyang Cai
- Department of Hematology/Oncology, Key Laboratory of Pediatric Hematology and Oncology of China Ministry of Health, National Children's Medical Center, Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
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9
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Thimotheo Batista JP, Santos Marzano LA, Menezes Silva RA, de Sá Rodrigues KE, Simões E Silva AC. Chemotherapy and Anticancer Drugs Adjustment in Obesity: A Narrative Review. Curr Med Chem 2023; 30:1003-1028. [PMID: 35946096 DOI: 10.2174/0929867329666220806140204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/08/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obese individuals have higher rates of cancer incidence and cancer- related mortality. The worse chemotherapy outcomes observed in this subset of patients are multifactorial, including the altered physiology in obesity and its impact on pharmacokinetics, the possible increased risk of underdosing, and treatment-related toxicity. AIMS The present review aimed to discuss recent data on physiology, providing just an overall perspective and pharmacokinetic alterations in obesity concerning chemotherapy. We also reviewed the controversies of dosing adjustment strategies in adult and pediatric patients, mainly addressing the use of actual total body weight and ideal body weight. METHODS This narrative review tried to provide the best evidence to support antineoplastic drug dosing strategies in children, adolescents, and adults. RESULTS Cardiovascular, hepatic, and renal alterations of obesity can affect the distribution, metabolism, and clearance of drugs. Anticancer drugs have a narrow therapeutic range, and variations in dosing may result in either toxicity or underdosing. Obese patients are underrepresented in clinical trials that focus on determining recommendations for chemotherapy dosing and administration in clinical practice. After considering associated comorbidities, the guidelines recommend that chemotherapy should be dosed according to body surface area (BSA) calculated with actual total body weight, not an estimate or ideal weight, especially when the intention of therapy is the cure. CONCLUSION The actual total body weight dosing appears to be a better approach to dosing anticancer drugs in both adults and children when aiming for curative results, showing no difference in toxicity and no limitation in treatment outcomes compared to adjusted doses.
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Affiliation(s)
- João Pedro Thimotheo Batista
- Laboratório Interdisciplinar de Investigação Médica (LIIM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), CEP 30.130-100, Avenida Professor Alfredo Balena, nº190/sl 281, Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Lucas Alexandre Santos Marzano
- Laboratório Interdisciplinar de Investigação Médica (LIIM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), CEP 30.130-100, Avenida Professor Alfredo Balena, nº190/sl 281, Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Renata Aguiar Menezes Silva
- Laboratório Interdisciplinar de Investigação Médica (LIIM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), CEP 30.130-100, Avenida Professor Alfredo Balena, nº190/sl 281, Santa Efigênia, Belo Horizonte, MG, Brazil
| | - Karla Emília de Sá Rodrigues
- Departmento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, CEP 30.130-100, Avenida Professor Alfredo Balena, nº190/sl 281, Santa Efgênia, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Laboratório Interdisciplinar de Investigação Médica (LIIM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), CEP 30.130-100, Avenida Professor Alfredo Balena, nº190/sl 281, Santa Efigênia, Belo Horizonte, MG, Brazil.,Departmento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, CEP 30.130-100, Avenida Professor Alfredo Balena, nº190/sl 281, Santa Efgênia, Belo Horizonte, MG, Brazil
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10
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Laurie KL, Lee P, Rademaker A, Alonzo TA, Wang YC, Powell BL, Wu D, Larson R, Kutny M, Gregory J, Hijiya N, Feusner J. Obesity in children with acute promyelocytic leukemia: What is its prevalence and prognostic significance? Pediatr Blood Cancer 2022; 69:e29613. [PMID: 35322524 PMCID: PMC9553282 DOI: 10.1002/pbc.29613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare outcomes of obese and nonobese pediatric patients with acute promyelocytic leukemia (APL) from the Cancer and Leukemia Group B trial (CALGB) 9710 and the Children's Oncology Group trial AAML0631. METHODS Data including demographics, adverse events, overall and event-free survival (EFS) were analyzed. RESULTS The prevalence of obesity was 34% on C9710 and 35% on AAML0631. There was significantly lower overall and EFS in the obese population on multivariable analysis on AAML0631 but not on CALGB 9710. Eleven patients died during therapy or in follow-up. CONCLUSION The prevalence of obesity is higher in pediatric patients with APL compared to the general population. The decreased EFS and OS in obese patients on AAML0631 suggest that the presence of obesity can influence outcomes using the most current treatment. These findings support the need for further research on the potential role of obesity in pediatric APL leukemogenesis.
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Affiliation(s)
- Kathryn L. Laurie
- Department of Pediatric Hematology/Oncology, Goryeb Children’s Hospital of Morristown Medical Center, Morristown, NJ
| | | | - Alfred Rademaker
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Todd A. Alonzo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Yi-Cheng Wang
- Department of Biostatistics, University of Southern California, Los Angeles, CA
| | - Bayard L. Powell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Diana Wu
- St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Matthew Kutny
- Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Nobuko Hijiya
- Division of Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY
| | - James Feusner
- Division of Pediatric Hematology Oncology, Children’s Hospital & Research Center Oakland, Benioff Children’s Hospital Oakland, Oakland, CA
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11
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Schab M, Skoczen S. The Role of Nutritional Status, Gastrointestinal Peptides, and Endocannabinoids in the Prognosis and Treatment of Children with Cancer. Int J Mol Sci 2022; 23:5159. [PMID: 35563548 PMCID: PMC9106013 DOI: 10.3390/ijms23095159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022] Open
Abstract
Neoplastic diseases in children are the second most frequent cause of death among the young. It is estimated that 400,000 children worldwide will be diagnosed with cancer each year. The nutritional status at diagnosis is a prognostic indicator and influences the treatment tolerance. Both malnutrition and obesity increase the risk of mortality and complications during treatment. It is necessary to constantly search for new factors that impair the nutritional status. The endocannabinoid system (ECS) is a signaling system whose best-known function is regulating energy balance and food intake, but it also plays a role in pain control, embryogenesis, neurogenesis, learning, and the regulation of lipid and glucose metabolism. Its action is multidirectional, and its role is being discovered in an increasing number of diseases. In adults, cannabinoids have been shown to have anti-cancer properties against breast and pancreatic cancer, melanoma, lymphoma, and brain tumors. Data on the importance of both the endocannabinoid system and synthetic cannabinoids are lacking in children with cancer. This review highlights the role of nutritional status in the oncological treatment process, and describes the role of ECS and gastrointestinal peptides in regulating appetite. We also point to the need for research to evaluate the role of the endocannabinoid system in children with cancer, together with a prospective assessment of nutritional status during oncological treatment.
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Affiliation(s)
- Magdalena Schab
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
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12
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Lee M, Hamilton JAG, Talekar GR, Ross AJ, Michael L, Rupji M, Dwivedi B, Raikar SS, Boss J, Scharer CD, Graham DK, DeRyckere D, Porter CC, Henry CJ. Obesity-induced galectin-9 is a therapeutic target in B-cell acute lymphoblastic leukemia. Nat Commun 2022; 13:1157. [PMID: 35241678 PMCID: PMC8894417 DOI: 10.1038/s41467-022-28839-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/11/2022] [Indexed: 12/25/2022] Open
Abstract
The incidence of obesity is rising with greater than 40% of the world’s population expected to be overweight or suffering from obesity by 2030. This is alarming because obesity increases mortality rates in patients with various cancer subtypes including leukemia. The survival differences between lean patients and patients with obesity are largely attributed to altered drug pharmacokinetics in patients receiving chemotherapy; whereas, the direct impact of an adipocyte-enriched microenvironment on cancer cells is rarely considered. Here we show that the adipocyte secretome upregulates the surface expression of Galectin-9 (GAL-9) on human B-acute lymphoblastic leukemia cells (B-ALL) which promotes chemoresistance. Antibody-mediated targeting of GAL-9 on B-ALL cells induces DNA damage, alters cell cycle progression, and promotes apoptosis in vitro and significantly extends the survival of obese but not lean mice with aggressive B-ALL. Our studies reveal that adipocyte-mediated upregulation of GAL-9 on B-ALL cells can be targeted with antibody-based therapies to overcome obesity-induced chemoresistance. Obesity has been reported to promote tumourigenesis and chemoresistance but the underlying mechanisms are not completely understood. Here, the authors show that adipocytes induce Galectin-9 (GAL-9) expression in B-acute lymphoblastic leukaemia (B-ALL) cells which leads to chemoresistance and antibody-mediated blockade of GAL-9 increases survival in preclinical B-ALL murine models.
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Affiliation(s)
- Miyoung Lee
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jamie A G Hamilton
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Ganesh R Talekar
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anthony J Ross
- Riley Pediatric Cancer and Blood Diseases, Riley Children's Health, Indiana University School of Medicine, Indianapolis, Indiana, IN, USA
| | | | - Manali Rupji
- Bioinformatics and Biostatistics Shared Resource, Winship Cancer Institute, Atlanta, GA, USA
| | - Bhakti Dwivedi
- Bioinformatics and Biostatistics Shared Resource, Winship Cancer Institute, Atlanta, GA, USA
| | - Sunil S Raikar
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Jeremy Boss
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher D Scharer
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Douglas K Graham
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Deborah DeRyckere
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Christopher C Porter
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Curtis J Henry
- Department of Pediatrics, Emory University School of Medicine and Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA.
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13
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Wadhwa A, Adams KM, Dai C, Richman JS, McDonald AM, Williams GR, Bhatia S. Association between body composition and chemotherapy-related toxicity in children with lymphoma and rhabdomyosarcoma. Cancer 2021; 128:1302-1311. [PMID: 34847257 DOI: 10.1002/cncr.34043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Body composition is associated with chemotherapy toxicity (chemotoxicity) in adults with cancer; this association remains unexplored in children with cancer. METHODS Using baseline computed tomography scans of 107 children with Hodgkin lymphoma (n = 45), non-Hodgkin lymphoma (n = 42), or rhabdomyosarcoma (n = 20), this study examined body composition (skeletal muscle index [SMI], skeletal muscle density [SMD], and height-adjusted total adipose tissue [hTAT]) to determine its association with chemotoxicity. Clinical characteristics and chemotoxicities were abstracted from medical records. Primary outcomes included grade 4 or higher hematologic toxicities and grade 3 or higher nonhematologic toxicities within 6 months of the diagnosis. Logistic regression models accounting for repeated measures were constructed to examine the association between body composition indices and chemotoxicities; adjustments were made for age at diagnosis, sex, race/ethnicity, cancer type, risk group, body mass index (measured as a percentile), or body surface area. RESULTS The median SMI was 41.0 cm2 /m2 (range, 25.8-68.6 cm2 /m2 ), the median SMD was 54.1 HU (range, 35-69.4 HU), and the median hTAT was 19.5 cm2 /m2 (range, 0-226.7 cm2 /m2 ). Grade 4 or higher hematologic toxicities and grade 3 or higher nonhematologic toxicities were observed in 74.7% and 66.3% of the chemotherapy cycles, respectively. A higher SMD at diagnosis was associated with lower odds of grade 4 or higher hematologic toxicity (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.85-0.97; P = .004). SMI (OR, 0.99; 95% CI, 0.95-1.04; P = .7) and hTAT (OR, 1.00; 95% CI, 0.99-1.01; P = .9) were not associated with hematologic toxicities. Nonhematologic toxicities did not show any association with body composition. CONCLUSIONS The association between low SMD and hematologic toxicities in children with lymphoma or rhabdomyosarcoma could be due to body composition-based biodistribution of chemotherapeutic agents and needs further investigation. LAY SUMMARY Body composition at cancer diagnosis in children with lymphoma and rhabdomyosarcoma may provide information that could identify those at risk for serious side effects from chemotherapy. Routinely used measures such as body mass index and body surface area show poor correlations with body composition assessed via computed tomography scans.
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Affiliation(s)
- Aman Wadhwa
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kandice M Adams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua S Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew M McDonald
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Smita Bhatia
- Division of Pediatric Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Egnell C, Heyman M, Jónsson ÓG, Raja RA, Niinimäki R, Albertsen BK, Schmiegelow K, Stabell N, Vaitkeviciene G, Lepik K, Harila-Saari A, Ranta S. Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia. Br J Haematol 2021; 196:1239-1247. [PMID: 34726257 DOI: 10.1111/bjh.17936] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023]
Abstract
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/m2 ; healthy weight, 17 to <25 kg/m2 ; overweight, 25 to <30 kg/m2 ; and obese, ≥30 kg/m2 . 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.
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Affiliation(s)
- Christina Egnell
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Mats Heyman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Raheel A Raja
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
| | - Riitta Niinimäki
- PEDEGO Research Unit, Medical Research Center Oulu and Department of Children and Adolescents, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Birgitte Klug Albertsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
| | - Niklas Stabell
- Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Goda Vaitkeviciene
- Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania
| | - Kristi Lepik
- Department of Haematology and Oncology, Children's hospital, Tallinn, Estonia
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Susanna Ranta
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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15
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Galati PC, Ribeiro CM, Pereira LTG, Amato AA. The association between excess body weight at diagnosis and pediatric leukemia prognosis: A systematic review and meta-analysis. Blood Rev 2021; 51:100870. [PMID: 34384603 DOI: 10.1016/j.blre.2021.100870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/16/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
Obesity affects the prognosis of several types of cancer. However, whether excess body weight is independently associated with adverse outcomes following initial pediatric acute leukemia (AL) treatment is still unclear. We conducted a systematic review and meta-analysis to investigate the impact of overweight/obesity at diagnosis on pediatric AL prognosis following initial treatment by performing an extensive database search up to January 22, 2021. Twenty-three studies were included, providing data for 15689 children with acute lymphoblastic leukemia (ALL) and 2506 children with acute myeloid leukemia (AML). Data from 12 studies were pooled in the meta-analysis. Children with overweight/obesity at diagnosis of ALL had poorer event free-survival (random-effects hazard ratio of 1.44, 95%CI 1.16-1.79, p = 0.0008), but no difference in overall survival (random-effects hazard ratio 1.33, 95%CI 0.77-2.29, p = 0.31) when compared with healthy-weight children. Children with overweight/obesity at diagnosis of AML had no difference in event-free survival (random-effects hazard ratio of 0.88, 95%CI 0.48-1.59, p = 0.66) or overall survival (random-effects hazard ratio 1.40, 95%CI 0.78-2.49, p = 0.26), when compared with healthy-weight children. This systematic review and meta-analysis indicates that overweight/obesity negatively affects the prognosis of children with ALL. Future studies should address the best approach to consider nutritional status in their management.
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Affiliation(s)
- Paula Cristina Galati
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Brasilia, Brazil; Children's Hospital of Brasilia José Alencar, Brasilia, Brazil
| | | | | | - Angélica Amorim Amato
- Laboratory of Molecular Pharmacology, School of Health Sciences, University of Brasilia, Brazil.
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16
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Jaime-Pérez JC, Turrubiates-Hernández GA, García-Salas G, de la Torre-Salinas AM, Áncer-Rodríguez P, Villarreal-Martínez L, Gómez-Almaguer D. The Influence of Nutritional Status at Diagnosis of Childhood B-Cell Acute Lymphoblastic Leukemia on Survival Rates: Data from a Hispanic Cohort. Nutr Cancer 2021; 74:889-895. [PMID: 34180310 DOI: 10.1080/01635581.2021.1934042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The impact of nutritional status at diagnosis of childhood acute lymphoblastic leukemia (ALL) on survival rates was assessed in a Hispanic cohort. Children <16 years with newly diagnosed ALL-B from 2011 to 2019 were studied. Overweight and obesity were classified by body mass index (BMI) and Z-score according to WHO and CDC criteria. BMI, weight percentiles for age and Z-Score were assessed using the WHO Anthro (0-5 years) and AnthroPlus (5-19 years) programs. Cox model was used to estimate risk factors for relapse and death; differences between groups were assessed with Student's T test for parametric and Mann-Whitney U test for non-parametric variables. Disease-free survival (DFS) and overall survival (OS) were determined by the Kaplan-Meier method, calculating time, status, cumulative survival and standard error with a 95% confidence interval. Equal data distribution was estimated with the log-rank test. One-hundred and seventy-two B-ALL children were studied. The overweight-obese group had a non-significant lower DFS (CDC: 54% vs. 60%, p = 0.80; WHO: 57% vs. 64%, p = 0.89) and OS rate (CDC:76% vs. 82%, p = 0.38; WHO:65% vs. 81%, p = 0.13). An association between nutritional status determined by CDC and WHO criteria at diagnosis of B-cell ALL and survival rates was not documented.
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Affiliation(s)
- José C Jaime-Pérez
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Grecia A Turrubiates-Hernández
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Gerardo García-Salas
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Anel M de la Torre-Salinas
- Clinical Nutrition, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Patricia Áncer-Rodríguez
- Clinical Nutrition, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - Laura Villarreal-Martínez
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
| | - David Gómez-Almaguer
- Department of Hematology, Dr. Jose Eleuterio González University Hospital and School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, México
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17
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Liu Q, Major B, Le-Rademacher J, Al-Kali AA, Alkhateeb H, Begna K, Elliott MA, Gangat N, Hogan WJ, Hook CC, Kaufmann SH, Pardanani A, Patnaik MS, Tefferi A, Wolanskyj-Spinner AP, Wei W, Litzow MR. The Impact of Obesity on the Outcomes of Adult Patients with Acute Lymphoblastic Leukemia - A Single Center Retrospective Study. BLOOD AND LYMPHATIC CANCER-TARGETS AND THERAPY 2021; 11:1-9. [PMID: 33519255 PMCID: PMC7837742 DOI: 10.2147/blctt.s269748] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/28/2020] [Indexed: 11/23/2022]
Abstract
Introduction Obesity is a worldwide problem that is related to cardiac disease, thrombosis and cancer. However, little is known about the impact of obesity on the outcomes of adult acute lymphoblastic leukemia (ALL) patients. Methods We retrospectively evaluated a cohort of 154 newly diagnosed adult ALL patients between 1994 and 2011 at Mayo Clinic (Rochester). According to the World Health Organization (WHO) international BMI classification, patients were stratified as underweight, normal weight, overweight, and obese. For some analyses, patients were also stratified according to a two-sided non-obese or obese classification. Results The median follow-up time was 8.37 years. Obese patients were more likely to be women (p=0.024) and ≥60 years old (p=0.003). Five-year mortality rates were higher in obese patients than non-obese [HR 95% CI: 1.60 (1.03-2.50) p=0.035]. This was also the case in subgroup analysis among T-cell patients although the number of patients was small [HR 95% CI: 5.42 (1.84-15.98) p<0.001]. There was no difference in mortality among the B-cell patients. After adjusting for baseline variables, the difference in mortality remained in several models. There was no difference in EFS or cumulative incidence of relapse rates between obese and non-obese patients among the overall population. Discussion In conclusion, our study suggests that adult ALL patients with obesity have lower survival rates, especially in T-cell ALL.
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Affiliation(s)
- Qiuju Liu
- Department of Cancer Center, Division of Hematology, Jilin University, Changchun, Jilin, People's Republic of China
| | - Brittny Major
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jennifer Le-Rademacher
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Aref A Al-Kali
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Hassan Alkhateeb
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kebede Begna
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Michelle A Elliott
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Naseema Gangat
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - William J Hogan
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - C Christopher Hook
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Scott H Kaufmann
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Animesh Pardanani
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Mrinal S Patnaik
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Ayalew Tefferi
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Wei Wei
- Department of Urology, Second Division, Jilin University, Changchun, Jilin, People's Republic of China
| | - Mark R Litzow
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
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18
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Diakatou V, Vassilakou T. Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. CHILDREN-BASEL 2020; 7:children7110218. [PMID: 33171756 PMCID: PMC7694979 DOI: 10.3390/children7110218] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
Malnutrition is caused either by cancer itself or by its treatment, and affects the clinical outcome, the quality of life (QOL), and the overall survival (OS) of the patient. However, malnutrition in children with cancer should not be accepted or tolerated as an inevitable procedure at any stage of the disease. A review of the international literature from 2014 to 2019 was performed. Despite the difficulty of accurately assessing the prevalence of malnutrition, poor nutritional status has adverse effects from diagnosis to subsequent survival. Nutritional status (NS) at diagnosis relates to undernutrition, while correlations with clinical outcome are still unclear. Malnutrition adversely affects health-related quality of life (HRQOL) in children with cancer and collective evidence constantly shows poor nutritional quality in childhood cancer survivors (CCSs). Nutritional assessment and early intervention in pediatric cancer patients could minimize the side effects of treatment, improve their survival, and reduce the risk of nutritional morbidity with a positive impact on QOL, in view of the potentially manageable nature of this risk factor.
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Affiliation(s)
- Vassiliki Diakatou
- Children’s & Adolescents’ Oncology Radiotherapy Department, Athens General Children’s Hospital “Pan. & Aglaia Kyriakou”, GR-11527 Athens, Greece;
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
- Correspondence: ; Tel.: +30-213-2010-283
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19
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Abstract
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer. Vincristine is a core chemotherapeutic agent for patients with ALL; unfortunately, ∼78% will develop vincristine-induced peripheral neuropathy (VIPN). VIPN can result in vincristine dose reductions that decrease therapeutic efficacy: making it important to understand which children are at highest risk for VIPN. We hypothesized that pediatric ALL patients who were obese at diagnosis would develop worse VIPN than healthy weight children with ALL within the first year. Our results confirmed that obese pediatric patients have significantly (P=0.03) worse VIPN than patients of healthy weight.
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20
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Egnell C, Ranta S, Banerjee J, Merker A, Niinimäki R, Lund B, Mogensen PR, Jonsson ÓG, Vaitkeviciene G, Lepik K, Forslund A, Heyman M, Harila-Saari A. Impact of body mass index on relapse in children with acute lymphoblastic leukemia treated according to Nordic treatment protocols. Eur J Haematol 2020; 105:797-807. [PMID: 32909636 PMCID: PMC7693088 DOI: 10.1111/ejh.13517] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/01/2022]
Abstract
Objectives High body mass index (BMI) is associated with poorer survival in childhood acute lymphoblastic leukemia (ALL), but the actual impact on the risk of relapse still needs to be clarified. We evaluated the impact of BMI at diagnosis on the risk of relapse in children with ALL treated according to Nordic Society of Paediatric Haematology and Oncology (NOPHO) protocols. Method In a multicenter study, we collected data on BMI at diagnosis and outcome of 2558 children aged 2.0‐17.9 years diagnosed between 1992 and 2016. Patients were divided into four groups according to International Obesity Task Force (IOTF) childhood BMI cut‐offs: underweight, <17; healthy weight, 17‐25; overweight, 25‐30; and obese, ≥30 kg/m2. Results In Cox multivariate regression analyses, an increased risk of relapse was observed in children aged 10‐17.9 years with unhealthy BMI at diagnosis (underweight hazard ratio HR: 2.90 [95% confidence interval: 1.24‐6.78], P = .01; overweight, HR: 1.95 [1.11‐3.43], P = .02, and obese HR: 4.32 [95% 2.08‐8.97], P < .001), compared to children with healthy weight. BMI had no impact on relapse in children under 10 years of age. Conclusion High BMI, and especially obesity at diagnosis, is an independent adverse prognostic factor for relapse in older children with ALL.
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Affiliation(s)
- Christina Egnell
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Ranta
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Joanna Banerjee
- Children and Adolescents Department, Helsinki University Hospital, Helsinki, Finland
| | - Andrea Merker
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Riitta Niinimäki
- PEDEGO Research Unit, Medical Research Center Oulu and Department of Children and Adolescents, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Bendik Lund
- Department of Pediatrics, St. Olavs University Hospital, and the Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pernille Rudebeck Mogensen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ólafur G Jonsson
- Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland
| | - Goda Vaitkeviciene
- Children's Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania
| | - Kristi Lepik
- Department of Haematology and Oncology, Tallin Children's Hospital, Tallin, Estonia
| | - Anders Forslund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mats Heyman
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Oncology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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21
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Orgel E, Sea JL, Mittelman SD. Mechanisms by Which Obesity Impacts Survival from Acute Lymphoblastic Leukemia. J Natl Cancer Inst Monogr 2020; 2019:152-156. [PMID: 31532535 DOI: 10.1093/jncimonographs/lgz020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/22/2019] [Accepted: 07/01/2019] [Indexed: 01/29/2023] Open
Abstract
The prevalence of obesity has steadily risen over the past decades, even doubling in more than 70 countries. High levels of body fat (adiposity) and obesity are associated with endocrine and hormonal dysregulation, cardiovascular compromise, hepatic dysfunction, pancreatitis, changes in drug metabolism and clearance, inflammation, and metabolic stress. It is thus unsurprising that obesity can affect the development of and survival from a wide variety of malignancies. This review focuses on acute lymphoblastic leukemia, the most common malignancy in children, to explore the multiple mechanisms connecting acute lymphoblastic leukemia, obesity, and adipocytes, and the implications for leukemia therapy.
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Affiliation(s)
- Etan Orgel
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA Department of Pediatrics, Keck School of Medicine, University of Southern California
| | - Jessica L Sea
- Division of Pediatric Endocrinology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, Los Angeles, CA
| | - Steven D Mittelman
- Division of Pediatric Endocrinology, UCLA Children's Discovery and Innovation Institute, David Geffen School of Medicine UCLA, Los Angeles, CA
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22
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Paviglianiti A. A Review on the Impact of Body Mass Index on Outcomes in Pediatric Leukemia. J Blood Med 2020; 11:205-212. [PMID: 32607038 PMCID: PMC7308124 DOI: 10.2147/jbm.s232655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 11/23/2022] Open
Abstract
In the last decades, adults and pediatric obesity have become a major issue in developed countries. Considerable research has been conducted in patients with acute lymphoblastic (ALL) and myeloid leukemia (AML) with the aim of correlating body mass index (BMI) and outcomes in patients undergoing chemotherapy for hematological diseases. In adults, a high BMI has been associated with increased leukemia-related mortality. Whether a similar effect exists in the pediatric setting remains controversial. Some of the studies detailed in this review have reported no differences in outcomes according to BMI, whilst other reports have described higher treatment-related mortality, increased risk of relapse and death. Although the link between BMI and acute leukemia outcomes is controversial, a large number of studies describe poorer survival rates in children with AML or ALL with higher BMI. On the other hand, being underweight has been associated with higher treatment-related toxicity. Understanding more about the impact of BMI in pediatric leukemia is of utmost importance to provide prompt intervention and improve outcomes.
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Affiliation(s)
- Annalisa Paviglianiti
- Department of Hematology and Stem Cell Transplantation, Saint Antoine Hospital, AP-HP, Paris, France
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23
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Pai MP, Debacker KC, Derstine B, Sullivan J, Su GL, Wang SC. Comparison of Body Size, Morphomics, and Kidney Function as Covariates of High‐Dose Methotrexate Clearance in Obese Adults with Primary Central Nervous System Lymphoma. Pharmacotherapy 2020; 40:308-319. [DOI: 10.1002/phar.2379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manjunath P. Pai
- Department of Clinical Pharmacy College of Pharmacy University of Michigan Ann Arbor Michigan
| | - Kenneth C. Debacker
- Department of Clinical Pharmacy College of Pharmacy University of Michigan Ann Arbor Michigan
| | - Brian Derstine
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
| | - June Sullivan
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
| | - Grace L. Su
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
- Department of Medicine VA Ann Arbor Health System Ann Arbor Michigan
| | - Stewart C. Wang
- Department of Surgery Michigan Medicine University of Michigan Ann Arbor Michigan
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24
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Abstract
Introduction: Obesity compromises survival in children with cancer in high-income countries (HICs) and is accompanied often by sarcopenia. In low and middle-income countries (LMICs), where the great majority of children live, the prevalence of under-nutrition is as high as 95% in those with cancer. Nutritional support improves clinical outcomes, including survival.Areas covered: This narrative review describes the evolution of attention to nutrition in children with cancer and the increasing understanding of this relationship. An initial focus on obesity in children with acute leukemias in HICs has been matched more recently by a recognition of the negative effect of under-nutrition on survival in children with cancer in LMICs. These observations have stimulated explorations of underlying mechanisms, including dysbiosis of the gut microbiome, and structured nutritional interventions to redress adverse outcomes.Expert opinion: Studies of the gut microbiome and metabolome have yielded important information on the pathogenesis of malnutrition in children, providing new avenues for interventions. Combinations of plant products that are inexpensive and readily available in LMICs have been shown to 'mature' the microbiome and the corresponding plasma proteome in children with acute malnutrition, offering the prospect of cost-effective remedies that are tested in children with cancer.
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Affiliation(s)
- Ronald D Barr
- Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Elena J Ladas
- Division of Hematology-Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University, Irving Medical Centre, New York, USA
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25
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Núñez-Enríquez JC, Gil-Hernández AE, Jiménez-Hernández E, Fajardo-Gutiérrez A, Medina-Sansón A, Flores-Lujano J, Espinoza-Hernández LE, Duarte-Rodríguez DA, Amador-Sánchez R, Peñaloza-González JG, Torres-Nava JR, Espinosa-Elizondo RM, Flores-Villegas LV, Merino-Pasaye LE, Pérez-Saldivar ML, Dorantes-Acosta EM, Cortés-Herrera B, Solis-Labastida KA, Núñez-Villegas NN, Velázquez-Aviña MM, Rangel-López A, González-Ávila AI, Santillán-Juárez JD, García-Velázquez AJ, Jiménez-Morales S, Bekker-Méndez VC, Rosas-Vargas H, Mata-Rocha M, Sepúlveda-Robles OA, Martín-Trejo JA, Mejía-Aranguré JM. Overweight and obesity as predictors of early mortality in Mexican children with acute lymphoblastic leukemia: a multicenter cohort study. BMC Cancer 2019; 19:708. [PMID: 31319816 PMCID: PMC6639907 DOI: 10.1186/s12885-019-5878-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/24/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Mexico City has one of the highest incidences and mortality rates of acute lymphoblastic leukemia (ALL) in the world and a high frequency of early relapses (17%) and early mortality (15%). Otherwise, childhood overweight and obesity are reaching epidemic proportions. They have been associated with poor outcomes in children with ALL. The aim of present study was to identify if overweight and obesity are predictors of early mortality and relapse in Mexican children with ALL. METHODS A multicenter cohort study was conducted. ALL children younger than 15 years old were included and followed-up during the first 24 months after diagnosis. Overweight and obesity were classified according World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) criteria. Early mortality and early relapses were the main outcomes. RESULTS A total of 1070 children were analyzed. Overweight/obesity at diagnosis were predictors of early mortality (WHO: HR = 1.4, 95%CI:1.0-2.0; CDC: HR = 1.6, 95%CI:1.1-2.3). However, no associations between overweight (WHO: HR = 1.5, 95%CI:0.9-2.5; CDC: HR = 1.0; 95% CI:0.6-1.6) and obesity (WHO: HR = 1.5, 95%CI:0.7-3.2; CDC: HR = 1.4; 95%CI:0.9-2.3) with early relapse were observed. CONCLUSIONS Overweight and obese patients embody a subgroup with high risk of dying during leukemia treatment.
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Affiliation(s)
- Juan Carlos Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Ana Elena Gil-Hernández
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Elva Jiménez-Hernández
- Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional "La Raza", IMSS, Mexico City, Mexico
| | - Arturo Fajardo-Gutiérrez
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Aurora Medina-Sansón
- Servicio de Hemato-Oncologia, Hospital Infantil de México Federico Gómez, Secretaria de Salud (SS), Mexico City, Mexico
| | - Janet Flores-Lujano
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Laura Eugenia Espinoza-Hernández
- Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional "La Raza", IMSS, Mexico City, Mexico
| | - David Aldebarán Duarte-Rodríguez
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Raquel Amador-Sánchez
- Servicio de Hematología Pediátrica, Hospital General Regional "Carlos McGregor Sánchez Navarro", IMSS, Mexico City, Mexico
| | | | - José Refugio Torres-Nava
- Servicio de Oncología, Hospital Pediátrico de Moctezuma, Secretaria de Salud de la Ciudad de México (SSCDMX), Mexico City, Mexico
| | | | - Luz Victoria Flores-Villegas
- Servicio de Hematología Pediátrica, Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Laura Elizabeth Merino-Pasaye
- Servicio de Hematología Pediátrica, Centro Médico Nacional "20 de Noviembre", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - María Luisa Pérez-Saldivar
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Elisa María Dorantes-Acosta
- Servicio de Hemato-Oncologia, Hospital Infantil de México Federico Gómez, Secretaria de Salud (SS), Mexico City, Mexico
| | | | - Karina Anastacia Solis-Labastida
- Servicio de Hematología Pediátrica UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", IMSS, Mexico City, Mexico
| | - Nora Nancy Núñez-Villegas
- Servicio de Hematología Pediátrica, Hospital General "Gaudencio González Garza", Centro Médico Nacional "La Raza", IMSS, Mexico City, Mexico
| | | | | | - Ana Itamar González-Ávila
- Servicio de Hematología Pediátrica, Hospital General Regional "Carlos McGregor Sánchez Navarro", IMSS, Mexico City, Mexico
| | | | | | - Silvia Jiménez-Morales
- Laboratorio de Genómica del Cáncer, Instituto Nacional de Medicina Genómica (INMEGEN), Mexico City, Mexico
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología "Dr. Daniel Méndez Hernández", "La Raza", IMSS, Mexico City, Mexico
| | - Haydee Rosas-Vargas
- Unidad de Investigación en Genética Humana, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", IMSS, Mexico City, Mexico
| | - Minerva Mata-Rocha
- Unidad de Investigación en Genética Humana, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", IMSS, Mexico City, Mexico
| | - Omar Alejandro Sepúlveda-Robles
- Unidad de Investigación en Genética Humana, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", IMSS, Mexico City, Mexico
| | - Jorge Alfonso Martín-Trejo
- Servicio de Hematología Pediátrica UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", IMSS, Mexico City, Mexico.
| | - Juan Manuel Mejía-Aranguré
- Unidad de Investigación Médica en Epidemiologia Clínica, UMAE Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico. .,Coordinación de Investigación en Salud, IMSS, Mexico City, Mexico.
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26
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Zimmerman KO, Benjamin DK, Becker ML, Anand R, Hornik CP. Product Labeling of Drugs Commonly Administered to Children and Adults with Obesity. PHARMACEUTICAL REGULATORY AFFAIRS : OPEN ACCESS 2019; 8:219. [PMID: 37220561 PMCID: PMC10201954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Obesity is a major public health problem that can affect drug disposition and dosing, particularly in vulnerable pediatric populations. Despite potentially detrimental consequences from inappropriately dosed drugs in children with obesity, drug product labels largely fail to include dosing or guidance specific to this population. Failure to include this information results in an increased incidence of adverse events, and concerns from treating physicians regarding their ability to provide appropriate care for children with obesity. Using data from the National Institute of Child Health and Human Development-funded Pediatric Trials Network (PTN), we explore possible ways to improve drug labeling in children with obesity. In order to improve health outcomes of children with obesity, carefully designed and executed PK trials and comprehensive PK analysis strategies are needed. Early collaboration with the Food and Drug Administration may be helpful in developing studies and analyses that are most beneficial for child health. This collaboration is particularly important for drugs that treat potentially life-threatening diseases, where inclusion of PK and dosing on the drug label is vital. We hope that increasing the body of knowledge on drug dosing in children with obesity will open the door to regulatory guidance based on extrapolation or population-specific PK studies, similar to other currently-recognized special populations. Given the magnitude of the pediatric obesity pandemic, recognition as a special population will offer substantial public health value.
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Affiliation(s)
- Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Mara L. Becker
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO
| | | | - Christoph P. Hornik
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
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27
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Gade C, Christensen HR, Dalhoff KP, Holm JC, Holst H. Inconsistencies in dosage practice in children with overweight or obesity: A retrospective cohort study. Pharmacol Res Perspect 2018; 6:e00398. [PMID: 29721323 PMCID: PMC5909170 DOI: 10.1002/prp2.398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/12/2018] [Indexed: 01/21/2023] Open
Abstract
Obesity can affect the pharmacokinetics of most drugs, which may result in under- or overdosing if traditional pediatric dosing strategies are used. To investigate currently applied dosage strategies in children with overweight or obesity (overweight/obesity), in a clinical treatment facility. In particular, whether dosing guidelines were available and metrics of body size applied. A retrospective cohort study of 200 patients admitted to the Danish Children's Obesity Clinic. Data were collected from 2007 to 2015. Overweight/obese children 3-18 years were included if they had at least one drug prescription. Overall there were 658 prescriptions, primarily analgesics, psychotropics, asthma medications, and antibiotics. Except for one prescription, guidelines for dosage of overweight/obese children were not available in the clinic. In one prescription of gentamicin, the dose was adjusted by a metric body size. Otherwise dose was predominately prescribed either by total body weight or as fixed dose by age, in accordance with the recommendations of normal weight children. In drugs with a narrow therapeutic interval, we found large interindividual variations in dosing regimens, that is, for gentamicin, paracetamol, and prednisolone. Reduction of dose to the maximum recommended adult dose was common practice, when the dose calculated by total body weight (ie, mg/kg) exceeded this maximum. This study highlights the shortage of dosing guidelines in overweight/obese children. We found a large interindividual variability in dosage regimens, even in drugs with narrow therapeutic intervals. The clinicians rely on "best practice", as evidence-based dosage regimens are missing for many drugs prescribed during childhood.
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Affiliation(s)
- Christina Gade
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
| | - Hanne R. Christensen
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
| | - Kim P. Dalhoff
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
| | - Jens Christian Holm
- Children's Obesity ClinicEuropean Center of Management (EASO)Department of PaediatricsZealand University HospitalHolbaekDenmark
| | - Helle Holst
- Department of Clinical PharmacologyCopenhagen University HospitalBispebjerg and FrederiksbergCopenhagen NVDenmark
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28
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Ren G, Cai W, Wang L, Huang J, Yi S, Lu L, Wang J. Impact of body mass index at different transplantation stages on postoperative outcomes in patients with hematological malignancies: a meta-analysis. Bone Marrow Transplant 2018; 53:708-721. [DOI: 10.1038/s41409-018-0234-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/02/2018] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
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29
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Li J, Wang C, Liu X, Liu Q, Lin H, Liu C, Jin F, Yang Y, Bai O, Tan Y, Gao S, Li W. Severe malnutrition evaluated by patient-generated subjective global assessment results in poor outcome among adult patients with acute leukemia: A retrospective cohort study. Medicine (Baltimore) 2018; 97:e9663. [PMID: 29505007 PMCID: PMC5779776 DOI: 10.1097/md.0000000000009663] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
To evaluate nutritional status in adult patients with acute leukemia (AL) using patient-generated subjective global assessment (PG-SGA) and to investigate the influence of nutritional status on prognosis.We observationally investigated 68 adult patients with newly diagnosed AL who received PG-SGA at the First Hospital of Jilin University between May 2013 and July 2015. Clinical features, chemotherapy regimens, biochemical indexes, body composition, complete remission (CR) rate, minimal residual disease (MRD), survival time, and side-effects of chemotherapy were compared between patients with and without severe malnutrition.Mean PG-SGA scores of the total patients were 6.1 ± 4.0, and 19 of 68 (27.9%) patients had severe malnutrition (PG-SGA score ≥9). Patients with acute myeloid leukemia (AML) had higher scores than those with acute lymphocytic leukemia (ALL; P = .011) and high-risk patients had higher scores regardless of whether they had AML or ALL (AML, P = .012; ALL, P = .043). Univariate analysis showed that severe malnutrition was correlated with age (P = .041), transferrin (P = .042), Karnofsky Performance Status score (P = .006), and C-reactive protein (CRP) (P = .018). Multivariate analysis demonstrated that severe malnutrition was associated with CRP (hazard ratio [HR] = 1.020, 95% confidence interval [CI]: 1.002-1.039, P = .026). No difference was found in CR rate (P = .831) between patients with and without malnutrition, but those who were severely malnourished had higher MRD (P = .048 in AML patients, P = .036 in ALL patients) and more gastrointestinal side-effects (P = .014). Severe malnutrition was also associated with inferior overall survival (HR = 0.243, 95% CI: 0.063-0.945, P = .041) but not with event-free survival (HR = 0.808, 95% CI: 0.338-1.934, P = .663).Severe malnutrition defined by PG-SGA in adult patients with de novo AL may result in poor outcome.
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Affiliation(s)
- Ji Li
- Departments of Gastroenterology
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Chang Wang
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Xiaoliang Liu
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Qiuju Liu
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Hai Lin
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Chunshui Liu
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Fengyan Jin
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Yan Yang
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Ou Bai
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Yehui Tan
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Sujun Gao
- Cancer Center, the First Hospital of Jilin University, Changchun, China
| | - Wei Li
- Cancer Center, the First Hospital of Jilin University, Changchun, China
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30
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Saenz AM, Stapleton S, Hernandez RG, Hale GA, Goldenberg NA, Schwartz S, Amankwah EK. Body Mass Index at Pediatric Leukemia Diagnosis and the Risks of Relapse and Mortality: Findings from a Single Institution and Meta-analysis. J Obes 2018; 2018:7048078. [PMID: 30515322 PMCID: PMC6236800 DOI: 10.1155/2018/7048078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 10/04/2018] [Indexed: 01/22/2023] Open
Abstract
High body mass index (BMI) is associated with relapse of certain adult cancers, but limited knowledge exists on its association with pediatric leukemia relapse. We evaluated the association between overweight/obesity (BMI ≥ 85th percentile) at pediatric leukemia diagnosis and relapse or mortality. A meta-analysis combining our findings with those of previous studies was also performed. The study included 181 pediatric leukemia patients. Sporadic missing data were multiply imputed, and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazard. Age- and sex-adjusted analysis for patients ≥10 years showed a trend towards increased risk of relapse for overweight/obese patients (HR = 2.89, 95% CI = 0.89-9.36, p=0.08) that was not evident among children<10 years (HR = 0.52, 95% CI = 0.08-3.54, p=0.49). We observed a statistically significant association between mortality and obesity status in unadjusted models (imputed: HR = 2.54, 95% CI = 1.15-5.60, p=0.021; complete set: HR = 2.72, 95% CI = 1.26-5.91, p=0.011) that was not statistically significant in both age- and sex-adjusted and multivariable adjusted analyses. The pooled estimate of our finding and previous studies showed an association between overweight/obese and increased risk of mortality for ALL (HR = 1.39, 95% CI = 1.16-1.46) and AML (HR = 1.64, 95% CI = 1.32-2.04). Although our study did not observe statistically significant associations due to a small sample size, the meta-analyses revealed an increased risk of mortality for overweight/obese patients. The findings of our study suggest an association of obesity status with relapse in children ≥10 years. However, our study was based on a small sample size from a single institution, and this association needs to be investigated in larger, multicenter studies.
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Affiliation(s)
- Ashleigh M. Saenz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Stacie Stapleton
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Raquel G. Hernandez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Greg A. Hale
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil A. Goldenberg
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
- Clinical and Translational Research Organization, All Children's Research Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Skai Schwartz
- Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Ernest K. Amankwah
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Paviglianiti A, Dalle JH, Ayas M, Boelens JJ, Volt F, Iori AP, de Souza MP, Diaz MA, Michel G, Locatelli F, Jubert C, Yakoub-Agha I, Bittencourt H, Bertrand Y, Kenzey C, Tozatto Maio K, Hayashi H, Rocha V, Bader P, Gluckman E, Ruggeri A. Low Body Mass Index Is Associated with Increased Risk of Acute GVHD after Umbilical Cord Blood Transplantation in Children and Young Adults with Acute Leukemia: A Study on Behalf of Eurocord and the EBMT Pediatric Disease Working Party. Biol Blood Marrow Transplant 2017; 24:799-805. [PMID: 29288817 DOI: 10.1016/j.bbmt.2017.12.790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/19/2017] [Indexed: 01/19/2023]
Abstract
Body mass index (BMI) may influence outcomes after allogeneic hematopoietic stem cell transplantation (HSCT). However, the impact of BMI on survival in children undergoing HSCT is not well defined, with conflicting results being reported on this issue. We analyzed 855 patients age 2 to 20 years with diagnosis of acute leukemia who underwent umbilical cord blood transplantation (UCBT) from 1990 to 2015. Patients were classified according to BMI as normal (fifth to 85th percentile), underweight (less than fifth percentile), overweight (85th to 95th percentile), and obese (>95th percentile) using growth charts for age and sex. All patients received single-unit UCBT after a myeloablative conditioning regimen. Diagnosis was acute lymphoblastic leukemia in 68% of the patients. Sixty-one percent of patients (n = 523) were in the normal BMI category, 11% (n = 96) were underweight, 16% (n = 137) overweight, and 12% (n = 99) obese. The cumulative incidence of grade II to IV acute graft-versus-host disease (aGVHD) was 35% (32% to 38%). According to pretransplantation BMI, aGVHD was 46% (33% to 59%) for underweight, 34% (31% to 42%) for normal, 36% (18% to 38%) for overweight, and 27% (15% to 37%) for obese (P = .04). In multivariate analysis, a BMI less than the fifth percentile was associated with higher incidence of acute grade II to IV GVHD compared with normal-BMI patients (hazard ratio, 1.61; 95% confidence interval, 1.15 to 2.26; P = .006). Our results show that being underweight at the time of transplantation is associated with an increased risk of aGVHD, highlighting the importance of nutritional status before UCBT.
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Affiliation(s)
- Annalisa Paviglianiti
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco.
| | - Jean Hugues Dalle
- Pediatric Hematology Department, Hospital Robert Debré, Paris, Paris 7-Paris Diderot University, Paris, France
| | - Mouhab Ayas
- Pediatric Stem Cell Transplant, Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Jan Jaap Boelens
- Department of Pediatrics, Pediatric Blood and Marrow Transplantation Program, University Medical Center, Utrecht, the Netherlands
| | - Fernanda Volt
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Anna Paola Iori
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | - Miguel Angel Diaz
- Stem Cell Transplant Unit, Hospital Universitario Niño Jesus, Madrid, Spain
| | - Gerard Michel
- Department of Pediatric Hematology and Oncology, Timone Enfants Hospital, APHM and Aix Marseille Université, Marseille, France
| | - Franco Locatelli
- Department of Paediatric Hematology and Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Bambino Gesù" Children's Hospital, Rome, Italy; Department of Pediatric Sciences, University of Pavia, Rome, Italy
| | - Charlotte Jubert
- Pediatric Hematology Department, Bordeaux-Hospital, Bordeaux University, Lille, France
| | | | - Henrique Bittencourt
- Department of Pediatrics, Charles-Bruneau Cancer Center, CHU Sainte-Justine, Montreal, Quebec, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Yves Bertrand
- Department of Child Hematology and Oncology, IHOP University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Chantal Kenzey
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Karina Tozatto Maio
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Hiromi Hayashi
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Peter Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Eliane Gluckman
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Annalisa Ruggeri
- Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco, Monaco; Hopital Saint Antoine, Service d'Hématologie et thérapie cellulaire, Paris, France
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The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia. Blood Cancer J 2017; 7:e531. [PMID: 28212374 PMCID: PMC5533940 DOI: 10.1038/bcj.2017.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/10/2017] [Indexed: 01/22/2023] Open
Abstract
The impact of body mass index (BMI) at diagnosis on treatment outcome in children with acute lymphoblastic leukemia (ALL) is controversial. We studied 373 children with ALL enrolled on the Total XV study, which prospectively used minimal residual disease (MRD) for risk assignment. MRD on day 19 and at the end of remission induction (day 46), cumulative incidence of relapse/refractory disease (CIR), event-free survival (EFS) and overall survival (OS) were evaluated using sets of four, three and two subgroups based on BMI at diagnosis, along with BMI percentile change during remission induction. Higher BMI was associated with older age and higher treatment risk. There was no association between MRD on days 19 or 46 and BMI for four, three or two BMI subgroups (P>0.1 in all cases), nor was BMI associated with CIR or EFS. Obese patients had worse OS compared with non-obese (P=0.031) due to treatment-related mortality and less salvage after refractory disease or bone marrow relapse. No association between BMI change during remission induction and MRD, CIR, EFS or OS was seen. BMI at diagnosis does not predict poorer response or relapse in a contemporary MRD-directed ALL regimen. Improvements in supportive care and innovative, less-toxic frontline/salvage therapies are needed, especially for obese patients.
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Martín-Trejo JA, Núñez-Enríquez JC, Fajardo-Gutiérrez A, Medina-Sansón A, Flores-Lujano J, Jiménez-Hernández E, Amador-Sanchez R, Peñaloza-Gonzalez JG, Alvarez-Rodriguez FJ, Bolea-Murga V, Espinosa-Elizondo RM, de Diego Flores-Chapa J, Pérez-Saldivar ML, Rodriguez-Zepeda MDC, Dorantes-Acosta EM, Núñez-Villegas NN, Velazquez-Aviña MM, Torres-Nava JR, Reyes-Zepeda NC, González-Bonilla CR, Flores-Villegas LV, Rangel-López A, Rivera-Luna R, Paredes-Aguilera R, Cárdenas-Cardós R, Martínez-Avalos A, Gil-Hernández AE, Duarte-Rodríguez DA, Mejía-Aranguré JM. Early mortality in children with acute lymphoblastic leukemia in a developing country: the role of malnutrition at diagnosis. A multicenter cohort MIGICCL study. Leuk Lymphoma 2016; 58:898-908. [DOI: 10.1080/10428194.2016.1219904] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Løhmann DJA, Abrahamsson J, Ha SY, Jónsson ÓG, Koskenvuo M, Lausen B, Palle J, Zeller B, Hasle H. Effect of age and body weight on toxicity and survival in pediatric acute myeloid leukemia: results from NOPHO-AML 2004. Haematologica 2016; 101:1359-1367. [PMID: 27470605 DOI: 10.3324/haematol.2016.146175] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/25/2016] [Indexed: 12/14/2022] Open
Abstract
Treatment for pediatric acute myeloid leukemia is very toxic and the association between outcome and age and Body Mass Index is unclear. We investigated effect of age and Body Mass Index on toxicity and survival in pediatric acute myeloid leukemia. We studied all patients who completed first induction course of NOPHO-AML 2004 (n=318). Toxicity following induction and consolidation courses (n=6) was analyzed. The probabilities of toxicity and death were determined using time-to-event analyses with Cox multivariate proportional hazard regression for comparative analyses. Age 10-17 years was associated with sepsis with hypotension [hazard ratio 2.3 (95% confidence interval 1.1-4.6)]. Being overweight (>1 standard deviation) was associated with requiring supplemental oxygen [1.9 (1.0-3.5)]. The 5-year event-free and overall survival were 47% and 71%. Children aged 10-17 years showed a trend for inferior 5-year overall survival compared to children aged 2-9 (64% vs. 76%; P=0.07). Infants showed a trend for superior 5-year event-free survival (66% vs. 43%; P=0.06). Overweight children aged 10-17 years showed a trend for superior survival [5-year event-free survival 59% vs. 40% (P=0.09) and 5-year overall survival 78% vs. 56% (P=0.06)] compared to healthy weight children aged 10-17 years. In conclusion, children aged 10-17 years and overweight children had a higher risk of grade 3-4 toxicity. Children aged 10-17 years showed inferior survival, but, unexpectedly, in this age group overweight children tended to have increased survival. This suggests different pharmacokinetics of chemotherapeutic drugs in adolescents and warrants further studies.
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Affiliation(s)
- Ditte J A Løhmann
- Department of Pediatrics, Aarhus University Hospital Skejby, Denmark
| | - Jonas Abrahamsson
- Institution for Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Shau-Yin Ha
- Department of Pediatrics, Queen Mary Hospital and Hong Kong Pediatric Hematology & Oncology Study Group (HKPHOSG), Hong Kong, China
| | | | - Minna Koskenvuo
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital and Helsinki University Central Hospital, Finland
| | - Birgitte Lausen
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Josefine Palle
- Department of Woman's and Children's Health, Uppsala University, Sweden
| | - Bernward Zeller
- Department of Pediatric Medicine, Oslo University Hospital, Norway
| | - Henrik Hasle
- Department of Pediatrics, Aarhus University Hospital Skejby, Denmark
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Chaudhuri J, Biswas T, Datta J, Sabui TK, Chatterjee S, Ray S, Raychaudhuri D, Mandal K, Chatterjee K, Chakraborty S. Evaluation of malnutrition as a predictor of adverse outcomes in febrile neutropenia associated with paediatric haematological malignancies. J Paediatr Child Health 2016; 52:704-9. [PMID: 27439631 DOI: 10.1111/jpc.13233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2016] [Indexed: 01/02/2023]
Abstract
AIM Malnutrition has been reported in the literature to be adversely associated with outcomes in paediatric malignancies. Our objective in this paper was to evaluate malnutrition as a potential predictor for adverse outcomes in febrile neutropenia associated with haematological malignancies. METHODS A prospective observational study was performed in a tertiary care teaching hospital of Kolkata, India. Forty-eight participants, suffering from haematological malignancy, were included. Participants were included if they experienced at least one episode of febrile neutropenia. For children aged <5 years, weight for height, height for age and weight for age were used as criteria for defining malnutrition, while body mass index for age was used in children ≥5 years. A total of 162 episodes of febrile neutropenia were studied. RESULTS Thirty patients (30/48, 62.5%) included in the study had malnutrition. In bivariate analyses at patient level, there is a strong association between malnutrition and death (odds ratio (OR) 7.286, 95% confidence interval (CI) 0.838-63.345, one-tailed P = 0.044), and life-threatening complications show a moderate trend towards significance (OR 3.333, 95% CI 0.791-14.052, one-tailed P = 0.084). Survival functions were significantly different between malnourished and non-malnourished children (log rank test χ(2) = 4.609, degree of freedom = 1, P = 0.032). Wasting was associated with life-threatening complications in children aged <5 years (OR 14, 95% CI 1.135-172.642, one-tailed P = 0.036). Logistic regression analyses at episode level revealed that phase of treatment and respiratory system involvement were significant predictors of death, while malnutrition was not. CONCLUSION Malnutrition may be a potential predictor of mortality in febrile neutropenia.
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Affiliation(s)
| | - Tamoghna Biswas
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | - Jyotishka Datta
- Department of Pediatric Medicine, KPC Medical College and Hospital, Kolkata, India
| | - Tapas Kumar Sabui
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | - Sukanta Chatterjee
- Department of Pediatric Medicine, Tripura Medical College and Dr BR Ambedkar Memorial Teaching Hospital, Agartala, Tripura, India
| | - Somosri Ray
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | | | - Kalyanbrata Mandal
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, India
| | | | - Swapna Chakraborty
- Department of Statistical Science, Duke University and Statistical and Applied Mathematical Sciences Institute, Durham, North Carolina, United States
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36
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Johnson PN, Miller JL, Hagemann TM, Moffett BS. Assessment of inpatient admissions and top 25 medications for obese pediatric patients at two academic hospitals. Am J Health Syst Pharm 2016; 73:1243-9. [PMID: 27354039 DOI: 10.2146/ajhp160005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Inpatient admissions and the top 25 medications for obese pediatric patients at two academic hospitals were assessed. METHODS Children age 2-17 years were included if they were obese and admitted to either hospital on or after January 1, 2011, and discharged before December 31, 2011. Obesity was defined as a body mass index of ≥95th percentile for age and sex. The objectives of this study were to determine the percentage of hospital admissions involving obese children and compile a list of medications prescribed to these patients. The top 25 medications prescribed were further evaluated to determine their pharmacokinetic disposition in obese patients. RESULTS Obese children accounted for 18.8% of the 15,119 admissions for children age 2-17 years at the two study hospitals. No significant difference was noted in the number of obese pediatric children admitted between institutions. A total of 28,234 medications were ordered for this population, with a median number of 8 medications prescribed per admission. Sixteen of the same medications (64.0%) ranked in the top 25 at each facility. The most commonly prescribed medications for these patients included analgesics, antimicrobials, corticosteroids, bronchodilators, and gastrointestinal agents. CONCLUSION Obese children accounted for 18.8% of admissions for patients age 2-17 years at two academic hospitals over a 1-year period. The most commonly prescribed medications for these children included analgesics, antimicrobials, corticosteroids, bronchodilators, and gastrointestinal agents. The literature guiding the dosing of these medications in this population was limited to seven studies, representing just three medications.
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Affiliation(s)
- Peter N Johnson
- Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK.
| | - Jamie L Miller
- Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, OK
| | - Tracy M Hagemann
- Nashville Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Nashville, TN
| | - Brady S Moffett
- Pediatric Cardiology, Texas Children's Hospital, Houston, TX
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Orgel E, Genkinger JM, Aggarwal D, Sung L, Nieder M, Ladas EJ. Association of body mass index and survival in pediatric leukemia: a meta-analysis. Am J Clin Nutr 2016; 103:808-17. [PMID: 26864366 PMCID: PMC6546230 DOI: 10.3945/ajcn.115.124586] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/28/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is a worldwide epidemic in children and adolescents. Adult cohort studies have reported an association between higher body mass index (BMI) and increased leukemia-related mortality; whether a similar effect exists in childhood leukemia remains controversial. OBJECTIVE We conducted a meta-analysis to determine whether a higher BMI at diagnosis of pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) is associated with worse event-free survival (EFS), overall survival (OS), and cumulative incidence of relapse (CIR). DESIGN We searched 4 electronic databases from inception through March 2015 without language restriction and included studies in pediatric ALL or AML (0-21 y of age) reporting BMI as a predictor of survival or relapse. Higher BMI, defined as obese (≥95%) or overweight/obese (≥85%), was compared with lower BMI [nonoverweight/obese (<85%)]. Summary risk estimates for EFS, OS, and CIR (ALL only) were calculated with random- or fixed-effects models according to tests for between-study heterogeneity. RESULTS Of 4690 reports identified, 107 full-text articles were evaluated, with 2 additional articles identified via review of citations; 11 articles were eligible for inclusion in this meta-analysis. In ALL, we observed poorer EFS in children with a higher BMI (RR: 1.35; 95% CI: 1.20, 1.51) than in those at a lower BMI. A higher BMI was associated with significantly increased mortality (RR: 1.31; 95% CI: 1.09, 1.58) and a statistically nonsignificant trend toward greater risk of relapse (RR: 1.17; 95% CI: 0.99, 1.38) compared with a lower BMI. In AML, a higher BMI was significantly associated with poorer EFS and OS (RR: 1.36; 95% CI: 1.16, 1.60 and RR: 1.56; 95% CI: 1.32, 1.86, respectively) than was a lower BMI. CONCLUSION Higher BMI at diagnosis is associated with poorer survival in children with pediatric ALL or AML.
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Affiliation(s)
- Etan Orgel
- Children's Center for Cancer and Blood Disease, Children's Hospital Los Angeles, Los Angeles, CA; Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, CA; Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Divya Aggarwal
- Institute of Human Nutrition, College of Physicians and Surgeons, and
| | - Lillian Sung
- Division of Haemotology/Oncology, The Hospital for Sick Kids, Toronto, Canada; and
| | - Michael Nieder
- Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Elena J Ladas
- Herbert Irving Comprehensive Cancer Center, Institute of Human Nutrition, College of Physicians and Surgeons, and Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY;
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38
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Effect of Malnutrition at Diagnosis on Clinical Outcomes of Children With Acute Lymphoblastic Leukemia. J Pediatr Hematol Oncol 2016; 38:107-10. [PMID: 26479995 DOI: 10.1097/mph.0000000000000428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute lymphoblastic leukemia (ALL) is the most common malignancy among children. Although studies have shown that malnutrition can negatively affect treatment outcome, results are controversial. This retrospective study aims at determining the prevalence of malnutrition and its association with treatment outcome among children with ALL treated at the Children's Cancer Institute in Lebanon. A total of 103 patients diagnosed with ALL between April 2002 and May 2010 were enrolled. Anthropometric data were collected from medical records upon diagnosis, at 3 and 6 months, and at the end of treatment. Body mass index was calculated for children 2 years of age and older, whereas weight-for-height ratio was used for patients below 2 years. Patients were considered underweight, stunted, or wasted if their Z-scores were <-2 SD. The prevalence of malnourished children was 25.2% at diagnosis and remained almost the same at the end of treatment. The odds of having a poor outcome (death and relapse) was higher among malnourished children and more so among stunted children with an odds ratios=2.15; 95% confidence interval, 0.5-8.3 and odds ratio=2.63; 95% confidence interval, 0.6-11.5, respectively. Although there was a trend showing worse outcomes in malnourished children with ALL at diagnosis when compared with well-nourished children larger studies using additional tools like arm anthropometry need to be conducted to prove the association.
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39
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Orgel E, Mueske NM, Sposto R, Gilsanz V, Freyer DR, Mittelman SD. Limitations of body mass index to assess body composition due to sarcopenic obesity during leukemia therapy. Leuk Lymphoma 2016; 59:138-145. [PMID: 26818609 DOI: 10.3109/10428194.2015.1136741] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Obesity as defined by body mass index percentile (BMI%) is strongly associated with relapse and poorer survival in childhood ALL. Whether BMI% accurately reflects body fat percentage (BF%) in this population is unknown. We conducted a prospective study assessing body composition during frontline ALL therapy. Dual-energy X-ray absorptiometry measured BF% and lean muscle mass (LMM) at diagnosis, end of Induction, and end of Delayed Intensification. Sarcopenic obesity (gain in BF% with loss of LMM) was surprisingly common during ALL treatment, resulting in poor correlation between changes in BMI% (expressed as Z-score) and BF% overall (r = -0.05) and within patients (r = -0.09). BMI Z-score and BF% changed in opposite directions in >50% of interval assessments. While BMI% at diagnosis is a suitable predictor of obesity/BF% for epidemiological studies, change in BMI% (as expressed as Z-score) does not reflect body composition. Studies evaluating obesity in leukemia should consider using direct measures of body composition.
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Affiliation(s)
- Etan Orgel
- a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.,b Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach , Long Beach , CA , USA.,c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA
| | - Nicole M Mueske
- d Children's Orthopaedic Center, Children's Hospital Los Angeles , Los Angeles , CA , USA
| | - Richard Sposto
- a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.,c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA
| | - Vicente Gilsanz
- e Department of Radiology , Children's Hospital Los Angeles , Los Angeles , CA , USA
| | - David R Freyer
- a Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles , Los Angeles , CA , USA.,c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA
| | - Steven D Mittelman
- c Department of Pediatrics, University of Southern California , Los Angeles , CA , USA.,f Center for Endocrinology, Children's Hospital Los Angeles , Los Angeles , CA , USA
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40
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Crysandt M, Kramer M, Ehninger G, Bornhäuser M, Berdel WE, Serve H, Röllig C, Kaifie A, Jost E, Brummendorf TH, Wilop S. A high BMI is a risk factor in younger patients withde novoacute myelogenous leukemia. Eur J Haematol 2015; 97:17-24. [DOI: 10.1111/ejh.12675] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Martina Crysandt
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - Michael Kramer
- Department of Internal Medicine I; University Hospital Carl Gustav Carus; Technische Universität Dresden; Dresden Germany
| | - Gerhard Ehninger
- Department of Internal Medicine I; University Hospital Carl Gustav Carus; Technische Universität Dresden; Dresden Germany
| | - Martin Bornhäuser
- Department of Internal Medicine I; University Hospital Carl Gustav Carus; Technische Universität Dresden; Dresden Germany
| | - Wolfgang E. Berdel
- Department of Medicine A, Hematology and Oncology; University Hospital of Muenster; Muenster Germany
| | - Hubert Serve
- Department of Medicine, Hematology/Oncology; Goethe-University; Frankfurt Germany
| | - Christoph Röllig
- Department of Internal Medicine I; University Hospital Carl Gustav Carus; Technische Universität Dresden; Dresden Germany
| | - Andrea Kaifie
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - Edgar Jost
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - Tim H. Brummendorf
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation; Medical Faculty; RWTH Aachen University; Aachen Germany
| | - Stefan Wilop
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation; Medical Faculty; RWTH Aachen University; Aachen Germany
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Pediatric Obesity: Pharmacokinetics and Implications for Drug Dosing. Clin Ther 2015; 37:1897-923. [DOI: 10.1016/j.clinthera.2015.05.495] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 02/01/2023]
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Harskamp-van Ginkel MW, Hill KD, Becker K, Testoni D, Cohen-Wolkowiez M, Gonzalez D, Barrett JS, Benjamin DK, Siegel DA, Banks P, Watt KM. Drug Dosing and Pharmacokinetics in Children With Obesity: A Systematic Review. JAMA Pediatr 2015; 169:678-85. [PMID: 25961828 PMCID: PMC4494887 DOI: 10.1001/jamapediatrics.2015.132] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Obesity affects nearly one-sixth of US children and results in alterations to body composition and physiology that can affect drug disposition, possibly leading to therapeutic failure or toxic side effects. The depth of available literature regarding obesity's effect on drug safety, pharmacokinetics, and dosing in obese children is unknown. OBJECTIVE To perform a systematic literature review describing the current evidence of the effect of obesity on drug disposition in children. EVIDENCE REVIEW We searched the MEDLINE, Cochrane, and EMBASE databases (January 1, 1970-December 31, 2012) and included studies if they contained data on drug clearance, volume of distribution, or drug concentration in obese children (aged ≤18 years). We compared exposure and weight-normalized volume of distribution and clearance between obese and nonobese children. We explored the association between drug physicochemical properties and clearance and volume of distribution. FINDINGS Twenty studies met the inclusion criteria and contained pharmacokinetic data for 21 drugs. The median number of obese children studied per drug was 10 (range, 1-112) and ages ranged from newborn to 29 years (1 study described pharmacokinetics in children and adults together). Dosing schema varied and were either a fixed dose (6 [29%]) or based on body weight (10 [48%]) and body surface area (4 [19%]). Clinically significant pharmacokinetic alterations were observed in obese children for 65% (11 of 17) of the studied drugs. Pharmacokinetic alterations resulted in substantial differences in exposure between obese and nonobese children for 38% (5 of 13) of the drugs. We found no association between drug lipophilicity or Biopharmaceutical Drug Disposition Classification System class and changes in volume of distribution or clearance due to obesity. CONCLUSIONS AND RELEVANCE Consensus is lacking on the most appropriate weight-based dosing strategy for obese children. Prospective pharmacokinetic trials in obese children are needed to ensure therapeutic efficacy and enhance drug safety.
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Affiliation(s)
- Margreet W. Harskamp-van Ginkel
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin D. Hill
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Kristian Becker
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Daniela Testoni
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | | | - Daniel Gonzalez
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Jeffrey S. Barrett
- Department of Clinical Pharmacology and Therapeutics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Daniel K. Benjamin
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - David A. Siegel
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Patricia Banks
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
| | - Kevin M. Watt
- Department of Pediatrics and Duke Clinical Research Institute, Duke University, Durham, NC
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Effect of Initial Body Mass Index on Survival Outcome of Patients With Acute Leukemia: A Single-Center Retrospective Study. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15 Suppl:S7-13. [DOI: 10.1016/j.clml.2015.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/03/2015] [Indexed: 11/18/2022]
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High body mass index did not result in poor outcome in Taiwanese children with acute myeloid leukemia: a single-institution experience. Int J Hematol 2015; 102:48-52. [DOI: 10.1007/s12185-015-1795-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 11/26/2022]
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45
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Omabe M, Ezeani M, Omabe KN. Lipid metabolism and cancer progression: The missing target in metastatic cancer treatment. J Appl Biomed 2015. [DOI: 10.1016/j.jab.2014.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Tolbert J, Kearns GL. The challenge of obesity in paediatric leukaemia treatment: it is not just size that matters. Arch Dis Child 2015; 100:101-5. [PMID: 25336436 DOI: 10.1136/archdischild-2014-307147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In the last two decades, tremendous advances have been made in the treatment of acute lymphocytic leukaemia (ALL) in children with 5 year 'cure' rates in excess of 90%. The maintenance of remission is due, in part, to individualisation of therapy which must consider age, body size, genetic constitution and the impact of disease on drug disposition and action. This review, focused on treatment of ALL and one of the therapeutic mainstays, 6-mercaptopurine, illustrates the importance of obesity as a modulating factor in dose individualisation.
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Affiliation(s)
- Jaszianne Tolbert
- Department of Pediatrics and Pharmacology, University of Missouri Kansas City, Kansas City, Missouri, USA Divisions of Hematology/Oncology, Clinical Pharmacology, Medical Toxicology and Therapeutic Innovation, The Children's Mercy Hospital, Kansas City, Missouri
| | - Gregory L Kearns
- Department of Pediatrics and Pharmacology, University of Missouri Kansas City, Kansas City, Missouri, USA Center for Children's Healthy Lifestyles and Nutrition, The Children's Mercy Hospital, Kansas City, Missouri, USA
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47
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Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia. Blood 2014; 124:3932-8. [PMID: 25349177 DOI: 10.1182/blood-2014-08-595389] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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48
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den Hoed MAH, Pluijm SMF, de Groot-Kruseman HA, te Winkel ML, Fiocco M, van den Akker ELT, Hoogerbrugge P, van den Berg H, Leeuw JA, Bruin MCA, Bresters D, Veerman AJP, Pieters R, van den Heuvel-Eibrink MM. The negative impact of being underweight and weight loss on survival of children with acute lymphoblastic leukemia. Haematologica 2014; 100:62-9. [PMID: 25304613 DOI: 10.3324/haematol.2014.110668] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Body mass index and change in body mass index during treatment may influence treatment outcome of pediatric patients with acute lymphoblastic leukemia. However, previous studies in pediatric acute lymphoblastic leukemia reported contradictory results. We prospectively collected data on body composition from a cohort of newly diagnosed Dutch pediatric patients with acute lymphoblastic leukemia (n=762, age 2-17 years). Patients were treated from 1997-2004 and the median follow-up was 9 years (range, 0-10). Body mass index at diagnosis was expressed as age- and gender-matched standard deviation scores and on the basis of these scores the patients were categorized as being underweight, of normal weight or overweight. Multivariate analyses showed that patients who were underweight (8%) had a higher risk of relapse [hazard ratio: 1.88, 95% confidence interval (1.13-3.13)], but similar overall survival and event-free survival as patients who had a normal weight or who were overweight. Patients with loss of body mass index during the first 32 weeks of treatment had a similar risk of relapse and event-free survival, but decreased overall survival [hazard ratio: 2.10, 95% confidence interval (1.14-3.87)] compared to patients without a loss of body mass index. In addition, dual X-ray absorptiometry scans were performed in a nested, single-center cohort. Data from these scans revealed that a loss of body mass consisted mainly of a loss of lean body mass, while there was a gain in the percentage of fat. In conclusion, being underweight at diagnosis is a risk factor for relapse, and a decrease in body mass index early during treatment is associated with decreased survival. In addition, loss of body mass during treatment seems to consist mainly of a loss of lean body mass. This study was approved by the Medical Ethical Committee in 1996 (trial number NTR460/SNWLK-ALL-9).
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Affiliation(s)
- Marissa A H den Hoed
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | - Saskia M F Pluijm
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | | | - Mariël L te Winkel
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam
| | - Martha Fiocco
- Dutch Childhood Oncology Group, The Hague Department of Medical Statistics and Bioinformatics, Leiden University Medical Center
| | | | - Peter Hoogerbrugge
- Department of Pediatric Hemato-Oncology, Nijmegen, Radboud University Medical Center Nijmegen
| | | | - Jan A Leeuw
- Dutch Childhood Oncology Group, The Hague Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen
| | - Marrie C A Bruin
- Dutch Childhood Oncology Group, The Hague University Medical Center Utrecht
| | - Dorine Bresters
- Dutch Childhood Oncology Group, The Hague Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden
| | - Anjo J P Veerman
- Dutch Childhood Oncology Group, The Hague VU University Medical Center, Amsterdam
| | - Rob Pieters
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam Dutch Childhood Oncology Group, The Hague
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Thompson P, Wheeler HE, Delaney SM, Lorier R, Broeckel U, Devidas M, Reaman GH, Scorsone K, Sung L, Dolan ME, Berg SL. Pharmacokinetics and pharmacogenomics of daunorubicin in children: a report from the Children's Oncology Group. Cancer Chemother Pharmacol 2014; 74:831-8. [PMID: 25119182 DOI: 10.1007/s00280-014-2535-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 07/09/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE We explored the impact of obesity, body composition, and genetic polymorphisms on the pharmacokinetics (PK) of daunorubicin in children with cancer. PATIENTS AND METHODS Patients ≤21 years receiving daunorubicin as an infusion of any duration <24 h for any type of cancer were eligible. Plasma drug concentrations were measured by high-performance liquid chromatography. Body composition was measured by dual-energy X-ray absorptiometry. Obesity was defined as a BMI >95% for age or as body fat >30%. NONMEM was used to perform PK model fitting. The Affymetrix DMET chip was used for genotyping. The impact of genetic polymorphisms was investigated using SNP/haplotype association analysis with estimated individual PK parameters. RESULTS A total of 107 subjects were enrolled, 98 patients had PK sampling, and 50 patients underwent DNA analysis. Population estimates for daunorubicin clearance and volume of distribution were 116 L/m(2)/h ± 14% and 68.1 L/m(2) ± 24%, respectively. Apparent daunorubicinol clearance and volume of distribution were 26.8 L/m(2)/h ± 5.6% and 232 L/m(2) ± 10%, respectively. No effect of body composition or obesity was observed on PK. Forty-four genes with variant haplotypes were tested for association with PK. FMO3-H1/H3 genotype was associated with lower daunorubicin clearance than FMO3-H1/H1, p = 0.00829. GSTP1*B/*B genotype was also associated with lower daunorubicin clearance compared to GSTP1*A/*A, p = 0.0347. However, neither of these associations was significant after adjusting for multiple testing by either Bonferroni or false discovery rate correction. CONCLUSIONS We did not detect an effect of body composition or obesity on daunorubicin PK. We found suggestive associations between FMO3 and GSTP1 haplotypes with daunorubicin PK that could potentially affect efficacy and toxicity.
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Affiliation(s)
- Patrick Thompson
- Texas Children's Cancer Center, Baylor College of Medicine, 1102 Bates Ave., Suite 1570, Houston, TX, 77030, USA
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Rogers PC. Nutritional Status As a Prognostic Indicator for Pediatric Malignancies. J Clin Oncol 2014; 32:1293-4. [DOI: 10.1200/jco.2014.55.0616] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Paul C.J. Rogers
- University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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