This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (34)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Obesity  • Alert me on articles by topic  Social Bookmarking   What's this?

Beverly J. Lange, MD; Robert B. Gerbing, MA; James Feusner, MD; Jeffrey Skolnik, MD; Nancy Sacks, MS, RD; Franklin O. Smith, MD; Todd A. Alonzo, PhD

JAMA. 2005;293:203-211.

Context  Current treatment for acute myeloid leukemia (AML) in children cures about half the patients. Of the other half, most succumb to leukemia, but 5% to 15% die of treatment-related complications. Overweight children with AML seem to experience excess life-threatening and fatal toxicity. Nothing is known about how weight affects outcomes in pediatric AML.

Objective  To compare survival rates in children with AML who at diagnosis are underweight (body mass index [BMI] 10th percentile), overweight (BMI 95th percentile), or middleweight (BMI = 11th-94th percentiles).

Design, Setting, and Participants  Retrospective review of BMI and survival in 768 children and young adults aged 1 to 20 years enrolled in Children’s Cancer Group-2961, an international cooperative group phase 3 trial for previously untreated AML conducted August 30, 1996, through December 4, 2002. Data were collected through January 9, 2004, with a median follow-up of 31 months (range, 0-78 months).

Main Outcome Measures  Hazard ratios (HRs) for survival and treatment-related mortality.

Results  Eighty-four of 768 patients (10.9%) were underweight and 114 (14.8%) were overweight. After adjustment for potentially confounding variables of age, race, leukocyte count, cytogenetics, and bone marrow transplantation, compared with middleweight patients, underweight patients were less likely to survive (HR, 1.85; 95% confidence interval [CI], 1.19-2.87; P = .006) and more likely to experience treatment-related mortality (HR, 2.66; 95% CI, 1.38-5.11; P = .003). Similarly, overweight patients were less likely to survive (HR, 1.88; 95% CI, 1.25-2.83; P = .002) and more likely to have treatment-related mortality (HR, 3.49; 95% CI, 1.99-6.10; P<.001) than middleweight patients. Infections incurred during the first 2 courses of chemotherapy caused most treatment-related deaths.

Conclusion  Treatment-related complications significantly reduce survival in overweight and underweight children with AML.

Author Affiliations: Division of Oncology (Dr Lange), The Children’s Hospital of Philadelphia (Dr Skolnik and Ms Sacks), Philadelphia, Pa; Children’s Oncology Group, Arcadia, Calif (Mr Gerbing); Children’s Hospital of Oakland, Oakland, Calif (Dr Feusner); Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (Dr Smith); and University of Southern California and Children’s Oncology Group, Los Angeles (Dr Alonzo).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Adipocytes Impair Leukemia Treatment in Mice
Behan et al.
Cancer Res. 2009;69:7867-7874.
ABSTRACT | FULL TEXT  

RUNX1 regulates phosphoinositide 3-kinase/AKT pathway: role in chemotherapy sensitivity in acute megakaryocytic leukemia
Edwards et al.
Blood 2009;114:2744-2752.
ABSTRACT | FULL TEXT  

FAS Promoter Polymorphism: Outcome of Childhood Acute Myeloid Leukemia. A Children's Oncology Group Report
Mehta et al.
Clin. Cancer Res. 2008;14:7896-7899.
ABSTRACT | FULL TEXT  

Structural and numerical variation of FLT3/ITD in pediatric AML
Meshinchi et al.
Blood 2008;111:4930-4933.
ABSTRACT | FULL TEXT  

Outcomes in CCG-2961, a Children's Oncology Group Phase 3 Trial for untreated pediatric acute myeloid leukemia: a report from the Children's Oncology Group
Lange et al.
Blood 2008;111:1044-1053.
ABSTRACT | FULL TEXT  

Detecting Anthracycline-induced Cardiotoxicity in Survivors of Childhood Cancer
Scully et al.
Am Soc Clin Oncol Ed Book 2008;2008:454-458.
ABSTRACT | FULL TEXT  

Obesity Is a Common Comorbidity in Children With Congenital and Acquired Heart Disease
Pinto et al.
Pediatrics 2007;120:e1157-e1164.
ABSTRACT | FULL TEXT  

Obesity and Outcome in Pediatric Acute Lymphoblastic Leukemia
Butturini et al.
JCO 2007;25:2063-2069.
ABSTRACT | FULL TEXT  

Minimally differentiated acute myeloid leukemia (FAB AML-M0) is associated with an adverse outcome in children: a report from the Children's Oncology Group, studies CCG-2891 and CCG-2961
Barbaric et al.
Blood 2007;109:2314-2321.
ABSTRACT | FULL TEXT  

Prognostic Factors and Risk-Based Therapy in Pediatric Acute Myeloid Leukemia
Meshinchi and Arceci
The Oncologist 2007;12:341-355.
ABSTRACT | FULL TEXT  

Body mass index does not influence pharmacokinetics or outcome of treatment in children with acute lymphoblastic leukemia
Hijiya et al.
Blood 2006;108:3997-4002.
ABSTRACT | FULL TEXT  

Clinical implications of FLT3 mutations in pediatric AML
Meshinchi et al.
Blood 2006;108:3654-3661.
ABSTRACT | FULL TEXT  

Ethnicity and survival in childhood acute myeloid leukemia: a report from the Children's Oncology Group
Aplenc et al.
Blood 2006;108:74-80.
ABSTRACT | FULL TEXT  

XPD Lys751Gln polymorphism in the etiology and outcome of childhood acute myeloid leukemia: a Children's Oncology Group report
Mehta et al.
Blood 2006;107:39-45.
ABSTRACT | FULL TEXT  

Recent Steroid Therapy Increases Severity of Varicella Infections in Children With Acute Lymphoblastic Leukemia
Hill et al.
Pediatrics 2005;116:e525-e529.
ABSTRACT | FULL TEXT  

A Multidisciplinary Review of Nutrition Considerations in the Pediatric Oncology Population: A Perspective From Children's Oncology Group
Ladas et al.
Nutr Clin Pract 2005;20:377-393.
ABSTRACT | FULL TEXT