As the obesity epidemic spreads in the United States, scientists are increasingly focusing on how body weight may affect health outcomes. AYAs with acute lymphoblastic leukemia (ALL) who have a high body mass index (BMI) may have poor treatment outcomes, according to recent research published in Blood Advances.
This study clarified how weight affects treatment side effects and outcomes and urges more research into how weight affects how well different chemotherapy regimens work. By 2020, 40 percent of the population in the United States will be obese, making it a growing public health problem. Study results suggest that obesity, as indicated by elevated BMI, may have a negative impact on how well AYAs respond to all therapy regimens.
“We’ve known for nearly fifteen years that obesity affects survival in all treated pediatric patients, and more recently, we’re recognizing a similar association in the adult population,” said Dr. Shai Shimoni, MD, told. and lead author of the related study. “But we wanted more detailed data on this, to understand why this correlation exists, and how dependent it is on age.”
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The investigators collected data from 388 AYAs aged 15-50 years, with a mean age of 24 years, who were being treated on the Dana-Farber Consortium pediatric regimen for ALL from 2008 to 2021. The researchers examined the relationship between BMI, age, and toxicity. and treatment outcomes in the group, aiming to identify any correlations or trends.
Overall, 53.3% of AYAs included in the study had a normal BMI, while 46.6% were classified as overweight or obese. Specifically, patients with overweight or obese BMI had higher rates of non-recurrence mortality (11.7% vs 2.8%), lower event-free survival rates (63% vs 77% at 4 years) and overall survival The survival rate was observed to be worse (64%). % versus 83%) compared to those with a normal BMI. It is important to note that the study found similar overall survival among younger (15–29) and older (30–50) AYAs with normal BMI (83% versus 85%, respectively), which is an incredibly important finding. This is because age is often considered an adverse prognostic feature in ALL.
Interestingly, the researchers found that the main factor for poor outcomes among the entire group was non-recurrence mortality, rather than disease recurrence. With respect to toxicity, liver enzyme and glucose levels were higher in patients considered to be overweight or obese (60.7% vs. 42.2%, and 36.4% vs. 24.4%, respectively).
In multivariable models for survival, higher BMI was associated with worse survival, whereas age was not associated with survival, and elevated triglycerides (fats in the bloodstream) were associated with better survival. Elevated triglycerides reflect the activity of one of the major chemotherapy drugs (asparaginase) included in the diet, and this finding suggests the potential use of this economical laboratory test as a biomarker of treatment efficacy. However, the researchers say this should not be viewed as an unfavorable conclusion.
Dr. Shimoni said, “This study highlights the association between increased BMI and increased treatment-related toxicity, non-recurrent mortality, and decreased overall survival in AYAs undergoing ALL treated with intensive pediatric regimens.” sheds light on the relationship. Study authors Dr. Daniel DeAngelo and Marlise Luskin also highlighted the effectiveness of the DFCI regimen in patients aged 18–50 years with a normal BMI.
It is important to acknowledge the limitations of this study, which include its retrospective nature, absence of data on measurable residual disease outcomes, and a mostly white population.
Additionally, the investigators emphasize that BMI, as well as other measures of obesity such as waist circumference, and waist-to-hip ratio, should be collected prospectively and used in multiple treatment contexts, including patients of all ages. Must be correlated with results. New regulations covering innovative treatments.
Dr. Shimoni emphasized, “Going forward, we hope that measures of obesity will be considered as an important variable in determining the most appropriate treatment regimen for each individual patient.”