Elevated BMI Associated with Increased Toxicity, Lower OS

Elevated body mass index (BMI) is associated with higher toxicity, higher nonrelapse mortality (NRM), and worse overall survival (OS) among adolescent and young adults (AYAs) with acute lymphoblastic leukemia (ALL), according to a study published in Blood Advances.

The trial, led by Shai Shimony, MD, of the Dana-Farber Cancer Institute (DFCI), studied the association of BMI on outcomes of 388 AYAs (aged 15-50 years) who were treated on DFCI consortium regimens from 2008 to 2021. BMI was normal in 207 (53.3%) patients and overweight/obese in 181 (46.7%) patients.

Comparing the overweight/obese group with the normal BMI group, four-year NRM was 11.7% versus 2.8%, respectively (P=.006); event-free survival was 63% versus 77% (P=.003); and OS was 64% versus 83% (P=.0001). Patients who were overweight/obese also experienced higher rates of grade 3/4 hepatotoxicity and hyperglycemia (60.7% vs 42.2%, P=.0005, and 36.4% vs 24.4%, P=.014, respectively), but had similar rates of hypertriglyceridemia (29.5% vs 24.4%, P=.29).

Overall, the effect of elevated BMI was more pronounced in older AYAs. Meanwhile, researchers found “excellent OS” among both younger (aged 15-29 years) and older AYAs (30-50 years) with normal BMI.

“Our findings emphasize that clinicians and clinical investigators should consider both age and BMI in making treatment decisions,” researchers wrote.

Reference

Shimony S, Flamand Y, Place A, et al. Effect of BMI on toxicities and survival among adolescents and young adults treated on DFCI Consortium ALL trials. 2023. Blood Advances, doi.org/10.1182/bloodadvances.2023009976