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Obesity in Survivors of Childhood Acute Lymphoblastic Leukemia and Lymphoma

Bassem I. Razzouk, Susan R. Rose, Suradej Hongeng, Dana Wallace, Matthew P. Smeltzer, Margie Zacher, Ching-Hon Pui, Melissa M. Hudson

From the Departments of Hematology/Oncology and Biostatistics, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN; Department of Endocrinology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; and the Department of Pediatrics, Mahidol University, Bangkok, Thailand

Address reprint requests to Bassem I. Razzouk, MD, Department of Hematology-Oncology, St Jude Children's Research Hospital, 332 N Lauderdale Ave, Memphis, TN 38105-2794; e-mail: bassem.razzouk{at}stjude.org

Purpose We evaluated the long-term effects of treatment on the body mass index (BMI) of children with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma who received one of three CNS-directed therapies: intrathecal methotrexate with intravenous high-dose methotrexate (1 g/m²), intrathecal methotrexate with 18 Gy cranial radiation, or intrathecal methotrexate with 24 Gy cranial radiation.

Patients and Methods Between 1979 and 1984, 456 children with newly diagnosed ALL and lymphoma were enrolled onto a single protocol at St Jude Children's Research Hospital (Memphis, TN). The heights and weights of 422 of the children were measured at diagnosis, during treatment, at the end of therapy, and approximately every 6 to 12 months thereafter. Patients who had attained their adult height at the time of analysis (n = 248) were placed in weight categories based on their BMI, BMI percentile, or weight-for-length percentile depending on age.

Results The overall percentage of survivors who were overweight or obese approximated rates prevalent in the general population of the United States. Young age (< 6 years) and overweight/obesity at diagnosis were the best predictors of obesity at adult height. The rate of BMI increase did not differ significantly between children who received radiation and those who did not, nor between patients who received 18 or 24 Gy of cranial radiation.

Conclusion BMI weight category at diagnosis, rather than type of CNS treatment received, predicted adult weight in long-term survivors of childhood hematologic malignancies.

Supported by Grant No. CA 21765 from the National Cancer Institute, by a Center of Excellence Grant from the State of Tennessee, and by the American Lebanese Syrian Associated Charities (ALSAC). C.-H.P. is the American Cancer Society-F.M. Kirby Clinical Research Professor.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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