Effect of body mass index on the outcome of children with acute myeloid leukemia

Hiroto Inaba, Harriet C. Surprise, Stanley Pounds, Xueyuan Cao, Scott Howard, Karen Ringwald-Smith, Jassada Buaboonnam, Gary Dahl, W. Paul Bowman, Jeffrey W. Taub, Dario Campana, Ching Hon Pui, Raul C. Ribeiro, Jeffrey E. Rubnitz

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Abstract

BACKGROUND: The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS: Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥85th percentile). RESULTS: Twenty-five patients (8%) were underweight, 86 patients (27.4%) were overweight/obese, and 203 patients (64.6%) had healthy weight. The 5-year overall survival rate of overweight/obese patients (46.5% ± 7.3%) was lower than the rate of patients with healthy weight (67.1% ± 4.3%; P <.001); underweight patients also tended to have lower survival rates (50.6% ± 10.7%; P =.18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P =.01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P =.03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P =.009). CONCLUSIONS: An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics- guided chemotherapy dosing, may improve outcome.

Original languageEnglish (US)
Pages (from-to)5989-5996
Number of pages8
JournalCancer
Volume118
Issue number23
DOIs
StatePublished - Dec 1 2012

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Acute Myeloid Leukemia
Body Mass Index
Thinness
Weights and Measures
Survival Rate
Child Mortality
Survival
Nutritional Support
Infection
Leukocyte Count
Physical Examination
Pharmacokinetics
Education
Recurrence
Drug Therapy
Mortality
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Inaba, H., Surprise, H. C., Pounds, S., Cao, X., Howard, S., Ringwald-Smith, K., ... Rubnitz, J. E. (2012). Effect of body mass index on the outcome of children with acute myeloid leukemia. Cancer, 118(23), 5989-5996. https://doi.org/10.1002/cncr.27640

Effect of body mass index on the outcome of children with acute myeloid leukemia. / Inaba, Hiroto; Surprise, Harriet C.; Pounds, Stanley; Cao, Xueyuan; Howard, Scott; Ringwald-Smith, Karen; Buaboonnam, Jassada; Dahl, Gary; Bowman, W. Paul; Taub, Jeffrey W.; Campana, Dario; Pui, Ching Hon; Ribeiro, Raul C.; Rubnitz, Jeffrey E.

In: Cancer, Vol. 118, No. 23, 01.12.2012, p. 5989-5996.

Research output: Contribution to journalArticle

Inaba, H, Surprise, HC, Pounds, S, Cao, X, Howard, S, Ringwald-Smith, K, Buaboonnam, J, Dahl, G, Bowman, WP, Taub, JW, Campana, D, Pui, CH, Ribeiro, RC & Rubnitz, JE 2012, 'Effect of body mass index on the outcome of children with acute myeloid leukemia', Cancer, vol. 118, no. 23, pp. 5989-5996. https://doi.org/10.1002/cncr.27640
Inaba, Hiroto ; Surprise, Harriet C. ; Pounds, Stanley ; Cao, Xueyuan ; Howard, Scott ; Ringwald-Smith, Karen ; Buaboonnam, Jassada ; Dahl, Gary ; Bowman, W. Paul ; Taub, Jeffrey W. ; Campana, Dario ; Pui, Ching Hon ; Ribeiro, Raul C. ; Rubnitz, Jeffrey E. / Effect of body mass index on the outcome of children with acute myeloid leukemia. In: Cancer. 2012 ; Vol. 118, No. 23. pp. 5989-5996.
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abstract = "BACKGROUND: The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS: Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥85th percentile). RESULTS: Twenty-five patients (8{\%}) were underweight, 86 patients (27.4{\%}) were overweight/obese, and 203 patients (64.6{\%}) had healthy weight. The 5-year overall survival rate of overweight/obese patients (46.5{\%} ± 7.3{\%}) was lower than the rate of patients with healthy weight (67.1{\%} ± 4.3{\%}; P <.001); underweight patients also tended to have lower survival rates (50.6{\%} ± 10.7{\%}; P =.18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P =.01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P =.03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P =.009). CONCLUSIONS: An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics- guided chemotherapy dosing, may improve outcome.",
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T1 - Effect of body mass index on the outcome of children with acute myeloid leukemia

AU - Inaba, Hiroto

AU - Surprise, Harriet C.

AU - Pounds, Stanley

AU - Cao, Xueyuan

AU - Howard, Scott

AU - Ringwald-Smith, Karen

AU - Buaboonnam, Jassada

AU - Dahl, Gary

AU - Bowman, W. Paul

AU - Taub, Jeffrey W.

AU - Campana, Dario

AU - Pui, Ching Hon

AU - Ribeiro, Raul C.

AU - Rubnitz, Jeffrey E.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - BACKGROUND: The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS: Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥85th percentile). RESULTS: Twenty-five patients (8%) were underweight, 86 patients (27.4%) were overweight/obese, and 203 patients (64.6%) had healthy weight. The 5-year overall survival rate of overweight/obese patients (46.5% ± 7.3%) was lower than the rate of patients with healthy weight (67.1% ± 4.3%; P <.001); underweight patients also tended to have lower survival rates (50.6% ± 10.7%; P =.18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P =.01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P =.03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P =.009). CONCLUSIONS: An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics- guided chemotherapy dosing, may improve outcome.

AB - BACKGROUND: The effect of body mass index (BMI) on the treatment outcomes of children with acute myeloid leukemia (AML) is unclear and needs further evaluation. METHODS: Children with AML (n = 314) who were enrolled in 4 consecutive St. Jude protocols were grouped according to BMI (underweight, <5th percentile; healthy weight, 5th to 85th percentile; and overweight/obese, ≥85th percentile). RESULTS: Twenty-five patients (8%) were underweight, 86 patients (27.4%) were overweight/obese, and 203 patients (64.6%) had healthy weight. The 5-year overall survival rate of overweight/obese patients (46.5% ± 7.3%) was lower than the rate of patients with healthy weight (67.1% ± 4.3%; P <.001); underweight patients also tended to have lower survival rates (50.6% ± 10.7%; P =.18). In a multivariable analysis that was adjusted for age, leukocyte count, French-American-British classification, and study protocols, patients with healthy weight had the best survival rate among the 3 groups (P =.01). When BMI was considered as continuous variable, patients with lower or higher BMI percentiles had worse survival (P =.03). There was no difference in the occurrence of induction failure or relapse among BMI groups, although underweight and overweight/obese patients had a significantly higher cumulative incidence of treatment-related mortality, especially because of infection (P =.009). CONCLUSIONS: An unhealthy BMI was associated with worse survival and more treatment-related mortality in children with AML. Meticulous supportive care with nutritional support and education, infection prophylaxis, and detailed laboratory and physical examination is required for these patients. These measures, together with pharmacokinetics- guided chemotherapy dosing, may improve outcome.

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