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Longitudinal Changes in Obesity and Body Mass Index Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report From the Childhood Cancer Survivor Study

Edward G. Garmey, Qi Liu, Charles A. Sklar, Lillian R. Meacham, Ann C. Mertens, Marilyn A. Stovall, Yutaka Yasui, Leslie L. Robison, Kevin C. Oeffinger

From the Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN; and Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX

Corresponding author: Kevin C. Oeffinger, MD, Departments of Pediatrics and Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021; e-mail: oeffingk{at}mskcc.org

Purpose We examined the rate of increase in the body mass index (BMI; kg/m²) after final height attainment in survivors of acute lymphoblastic leukemia (ALL) and a noncancer comparison group.

Methods Childhood Cancer Survivor Study (CCSS) is a retrospectively ascertained cohort study that prospectively tracks the health status of adults who were diagnosed with childhood cancer between 1970 and 1986 and a comparison group of siblings. Changes in BMI from baseline enrollment to time of completion of follow-up (mean interval, 7.8 years) were calculated for 1,451 ALL survivors (mean age, 32.3 years at follow-up) and 2,167 siblings of childhood cancer survivors (mean age, 35.9 years).

Results The mean BMI of the CCSS sibling comparison group increased with age (women, 0.25 units/yr, 95% CI, 0.22 to 0.28 units; men, 0.23 units/yr, 95% CI, 0.20 to 0.25 units). Compared with CCSS siblings, ALL survivors who were treated with cranial radiation therapy (CRT) had a significantly greater increase in BMI (women, 0.41 units/yr, 95% CI, 0.37 to 0.45 units; men, 0.29 units/yr; 95% CI, 0.26 to 0.32 units). The rate of BMI increase was not significantly increased for ALL survivors who were treated with chemotherapy alone. Younger age at CRT exposure significantly modified risk.

Conclusion CRT used in the treatment of childhood ALL is associated with a greater rate of increasing BMI, particularly among women treated with CRT during the first decade of life. Health care professionals should be aware of this risk and interventions to reduce or manage weight gain are essential in this high-risk population.

Supported by Grant No. U24-CA-55727 (L.L.R., principal investigator) and Grant No. R01-CA-100474 (K.C.O., principal investigator) from the United States Department of Health and Human Services, funding to the University of Minnesota from the Children's Cancer Research Fund, and funding to St Jude Children's Research Hospital from the American Lebanese Syrian Associated Charities.

K.C.O. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding organizations had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

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

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