Associations between Pre-therapeutic Body Mass Index, Outcome and Cytogenetic Abnormalities in Pediatric Acute Myeloid Leukemia

• Introduction: Associations between body mass index (BMI), outcome and leukemia-related factors in children with acute myeloid leukemia (AML) are unclear. Aim: To investigate associations between pre-therapeutic BMI, cytogenetic abnormalities, and outcome in a large multinational cohort of children with AML. Methods: We included patients age 2–17 years, diagnosed with de novo AML from the five Nordic countries (2004–2016), Hong Kong (2007–2016), the Netherlands and Belgium (2010–2016), and Canada and USA (1995–2012). Cases with Down syndrome, acute promyelocytic leukemia, or isolated granulocytic sarcoma were excluded. Cases with missing data on pre-therapeutic BMI (n=7) were also excluded. BMI standard deviations score for age and sex was calculated and categorized according to the World Health Organization. Cumulative incidence functions, Cox regression and logistic regression were used to investigate associations. Results: In total, 867 patients were included. The median age was 10 years (range 2–17 years) and 53% were male. At diagnosis, 4% were underweight, 73% were healthy weight, 15% were overweight, and 9% were obese. Patients were treated on 17 different protocols with AAML0531, COG9421, NOPHO-AML 2004, DB AML-01 and NOPHO-DBH AML 2012 accounting for 79%. There was no difference in relapse risk, treatment-related mortality or overall mortality across BMI groups. The frequency of t(8;21) and inv(16) increased with increasing BMI. For obese patients, the sex, age and country adjusted odds ratio of having t(8;21) or inv(16) were 1.9 (95% confidence interval (CI) 1.1–3.4) and 2.8 (95% CI 1.3–5.8) respectively compared to healthy weight patients. Conclusion: This multi-institutional study of 867 pediatric patients with de novo AML did not confirm previous reports of associations between overweight and increased treatment-related or overall mortality in children. Obesity was associated with a higher frequency of t(8;21) and inv(16). AML cytogenetics appear to differ by BMI status.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Pediatrik (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Pediatrics (hsv//eng)

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