Risk Factors for Obesity and Time Frame of Weight Gain in Non-Irradiated Survivors of Pediatric Acute Lymphoblastic Leukemia

Abstract

Background: Obesity has been described among survivors of pediatric Acute Lymphoblastic Leukemia (ALL), especially those who have received cranial radiation. This study aims to evaluate the prevalence of overweight or obesity in pediatric ALL survivors who were not exposed to radiation, identify the time frame in which the rate of obesity rise is the greatest, and identify contributing clinical and treatment variables. Methods: In this retrospective, single institution study, the charts of 132 ALL survivors were reviewed. Odds Ratios (OR) and 95% Confidence Intervals (CI) were calculated for being overweight or obese at their 2 year follow-up for the following clinical variables: ethnicity, age at diagnosis, and weight at diagnosis. Changes in BMI percentiles between 4 different time points were assessed using t-test comparison and p values. Results: Survivors of ALL were more likely to be overweight or obese than the general population at the 2 and 5 year follow-up. White and Hispanic ethnicity and being overweight or obese at diagnosis were also risk factors for being overweight or obese 2 years after the end of treatment. When looking at the time frame of weight gain, survivors had a significant increase in BMI percentile between diagnosis and end of therapy, and between diagnosis and 2 year follow-up, but did not have a significant increase between end of therapy and 2 year follow-up. Conclusion: Patients with ALL have an increased risk of being obese at follow-up. They show early weight gain, between diagnosis and end of treatment, and remain overweight/obese long term. Ethnicity and BMI weight category at diagnosis were significant influences. A strategic plan to prevent this weight gain should be implemented early during therapy.