Weight patterns in children with higher risk ALL: A report from the Children's Oncology Group (COG) for CCG 1961

Janice S. Withycombe, Janice E. Post-White, Jane L Meza, Ria G. Hawks, Lynette M Smith, Nancy Sacks, Nita L. Seibel

Research output: Contribution to journalArticle

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Abstract

Background. This retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961. Procedure. Patients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 x ln(BMI/median BMI). Results. By the end of treatment, 23% of children were obese (BMI ≥95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5-9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity. Conclusions. Successful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5-9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction.

Original languageEnglish (US)
Pages (from-to)1249-1254
Number of pages6
JournalPediatric Blood and Cancer
Volume53
Issue number7
DOIs
StatePublished - Dec 15 2009

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Precursor Cell Lymphoblastic Leukemia-Lymphoma
Weights and Measures
Hispanic Americans
Therapeutics
Obesity
Maintenance
Idarubicin
Cranial Irradiation
Pancreatitis
Doxorubicin
Radiation
Glucose
Neoplasms

Keywords

  • Cancer
  • Childhood
  • Leukemia
  • Obesity
  • Weight

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Weight patterns in children with higher risk ALL : A report from the Children's Oncology Group (COG) for CCG 1961. / Withycombe, Janice S.; Post-White, Janice E.; Meza, Jane L; Hawks, Ria G.; Smith, Lynette M; Sacks, Nancy; Seibel, Nita L.

In: Pediatric Blood and Cancer, Vol. 53, No. 7, 15.12.2009, p. 1249-1254.

Research output: Contribution to journalArticle

Withycombe, Janice S. ; Post-White, Janice E. ; Meza, Jane L ; Hawks, Ria G. ; Smith, Lynette M ; Sacks, Nancy ; Seibel, Nita L. / Weight patterns in children with higher risk ALL : A report from the Children's Oncology Group (COG) for CCG 1961. In: Pediatric Blood and Cancer. 2009 ; Vol. 53, No. 7. pp. 1249-1254.
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N2 - Background. This retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961. Procedure. Patients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 x ln(BMI/median BMI). Results. By the end of treatment, 23% of children were obese (BMI ≥95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5-9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity. Conclusions. Successful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5-9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction.

AB - Background. This retrospective analysis defined and described patterns and predictors of weight change during treatment in children with acute lymphocytic leukemia (ALL) with high-risk features who received treatment on Children's Cancer Group protocol CCG 1961. Procedure. Patients (1,638) were enrolled in CCG 1961 from November 1996 to May 2002. Weight was measured as BMI percent (%), specific for age and gender, and defined as 100 x ln(BMI/median BMI). Results. By the end of treatment, 23% of children were obese (BMI ≥95%), compared with 14% at diagnosis. Children who received post-induction intensified therapy (arms C, D, SER with Doxorubicin or Idarubicin) had higher gastrointestinal toxicities and lower BMI% from consolidation through interim maintenance 1. BMI% then increased for all arms between delayed intensification and maintenance 1 or 2. Children who were of Black or Hispanic race, obese at diagnosis, or who had grade 3 or 4 pancreatitis/glucose toxicities during induction had higher BMI% throughout treatment. Children were more likely to be obese at the end of the study if they were aged 5-9 years at diagnosis or female gender. Cranial radiation was not a predictor of obesity. Conclusions. Successful treatment of higher risk childhood ALL was associated with obesity, independent of cranial irradiation. The beginning of maintenance therapy may be the best time to intervene with nutritional and behavioral interventions, particularly for children who are obese or aged 5-9 years at diagnosis, female, Black or Hispanic, or those with metabolic toxicities during induction.

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