University of Oulu

Egnell, C, Ranta, S, Banerjee, J, et al. Impact of body mass index on relapse in children with acute lymphoblastic leukemia treated according to Nordic treatment protocols. Eur. J. Haematol.. 2020; 105: 797– 807.

Impact of body mass index on relapse in children with acute lymphoblastic leukemia treated according to Nordic treatment protocols

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Author: Egnell, Christina1,2; Ranta, Susanna1,2; Banerjee, Joanna3;
Organizations: 1Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
2Department of Pediatric Oncology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
3Children and Adolescents Department, Helsinki University Hospital, Helsinki, Finland
4PEDEGO Research Unit, Medical Research Center Oulu and Department of Children and Adolescents, Oulu University Hospital and University of Oulu, Oulu, Finland
5Department of Pediatrics, St. Olavs University Hospital, and the Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
6Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
7Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland
8Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania
9Department of Haematology and Oncology, Tallin Children’s Hospital, Tallin, Estonia
10Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: John Wiley & Sons, 2020
Publish Date: 2021-01-21


Objectives: High body mass index (BMI) is associated with poorer survival in childhood acute lymphoblastic leukemia (ALL), but the actual impact on the risk of relapse still needs to be clarified. We evaluated the impact of BMI at diagnosis on the risk of relapse in children with ALL treated according to Nordic Society of Paediatric Haematology and Oncology (NOPHO) protocols.

Method: In a multicenter study, we collected data on BMI at diagnosis and outcome of 2558 children aged 2.0‐17.9 years diagnosed between 1992 and 2016. Patients were divided into four groups according to International Obesity Task Force (IOTF) childhood BMI cut‐offs: underweight, <17; healthy weight, 17‐25; overweight, 25‐30; and obese, ≥30 kg/m².

Results: In Cox multivariate regression analyses, an increased risk of relapse was observed in children aged 10‐17.9 years with unhealthy BMI at diagnosis (underweight hazard ratio HR: 2.90 [95% confidence interval: 1.24‐6.78], P = .01; overweight, HR: 1.95 [1.11‐3.43], P = .02, and obese HR: 4.32 [95% 2.08‐8.97], P < .001), compared to children with healthy weight. BMI had no impact on relapse in children under 10 years of age.

Conclusion: High BMI, and especially obesity at diagnosis, is an independent adverse prognostic factor for relapse in older children with ALL.

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Series: European journal of haematology
ISSN: 0902-4441
ISSN-E: 1600-0609
ISSN-L: 0902-4441
Volume: 105
Issue: 6
Pages: 797 - 807
DOI: 10.1111/ejh.13517
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Funding: This work was supported by Barncancerfonden grant TJ2018‐0093.
Copyright information: © 2020 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.