Is There a Link Between BMI, Treatment Outcomes in Younger Patients with ALL?

A higher body mass index (BMI) was associated with increased toxicity, nonrelapse mortality (NRM), and decreased overall survival (OS) in adolescents and young adults with acute lymphoblastic leukemia (ALL), according to a recent study.

Shai Shimony, MD, of the Dana-Farber Cancer Institute, and colleagues conducted the research and published their findings in Blood Advances.

“We have known for roughly fifteen years that obesity affects survival in pediatric patients treated for ALL, and more recently, we are recognizing a similar relationship in adult populations,” Dr. Shimony said in a news release. “But we wanted more granular data on this, to understand why this correlation exists, and how dependent it is on age.”

The study included 388 patients with ALL who were aged 15 to 50 years and received Dana-Farber Consortium regimens between 2008 and 2021. The researchers reported that 53.3% of patients had a BMI within a normal range, while 46.7% had a BMI in the overweight or obese range. However, 79% of patients aged 15 to 29 years had a BMI within the normal range, compared with 20% of patients who were older (P<.0001).

The four-year NRM rate was 11.7% in patients with a BMI in the overweight or obese range, while it was 2.8% in those with a BMI in the normal range (P=.006). The four-year OS rate was 64% in patients with a BMI in the overweight or obese range, significantly lower than the rate of 83% in patients with a BMI in the normal range (P=.0001).

“Interestingly, researchers found that the main factor driving worse outcomes among the entire cohort was nonrelapse mortality, rather than disease relapse,” officials said in the news release.

The researchers also conducted separate analyses in each BMI group due to BMI differences among age groups. In patients with a BMI in the normal range, the four-year OS rate was 85% in patients aged 15 to 29 years, while it was 83% in patients aged 30 to 50 years (P=.89).

This is “incredibly important finding, as age is often considered an adverse prognostic feature in ALL,” according to the news release.

However, in patients with a BMI in the overweight or obese range, the four-year OS rate was 55% in older patients, while it was 73% in younger patients (P=.023).

Higher rates of grade 3 to 4 hepatotoxicity occurred in patients with a BMI in the overweight to obese range (60.7%) than in those with a BMI in the normal range (42.2%; P=.0005). The researchers also reported higher rates of grade 3 to 4 hyperglycemia in patients with a BMI in the overweight to obese range (36.4%) than in those with a BMI in the normal range (24.4%; P=.0014). However, the rates of hypertriglyceridemia were similar between patients with a BMI in the overweight to obese range (29.5%) and those with a BMI in the normal range (24.4%; P=.29).

“This study highlights the association between elevated BMI and increased treatment-related toxicity, non-relapse mortality, and decreased overall survival in [adolescents and young adults] undergoing treatment for ALL with intensive pediatric regimens,” Dr. Shimony said..

The study’s limitations included its retrospective nature, the lack of information on measurable residual disease outcomes, and the mostly White population. The researchers emphasized that BMI and other measures should be prospectively collected and correlated with outcomes in multiple contexts.

“Moving forward, we hope that measures of obesity will be considered a vital variable in determining the most suitable treatment regimens for each individual patient,” Dr. Shimony said..

Reference

Shimony S, Flamand Y, Valtis YK, et al. Effect of BMI on toxicities and survival among adolescents and young adults treated on DFCI consortium ALL trials. Blood Adv. 2023. doi:10.1182/bloodadvances.2023009976