University of Oulu

Egnell, C., Heyman, M., Jónsson, Ó.G., Raja, R.A., Niinimäki, R., Albertsen, B.K., Schmiegelow, K., Stabell, N., Vaitkeviciene, G., Lepik, K., Harila-Saari, A. and Ranta, S. (2022), Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia. Br J Haematol, 196: 1239-1247.

Obesity as a predictor of treatment-related toxicity in children with acute lymphoblastic leukaemia

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Author: Egnell, Christina1,2; Heyman, Mats2; Jónsson, Ólafur Gisli3;
Organizations: 1Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
2Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
3Children’s Hospital, Landspitali University Hospital, Reykjavik, Iceland
4Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
5Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Denmark
6PEDEGO Research Unit, Medical Research Center Oulu and Department of Children and Adolescents, Oulu University Hospital and University of Oulu, Oulu, Finland
7Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
8Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
9Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
10Children’s Hospital, Affiliate of Vilnius University Hospital Santaros Klinikos and Vilnius University, Vilnius, Lithuania
11Department of Haematology and Oncology, Children's hospital, Tallinn, Estonia
12Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-06-17


Obesity is associated with poor outcomes in childhood acute lymphoblastic leukaemia (ALL). We explored whether severe treatment-related toxicity and treatment delays could explain this observation. This study included 1 443 children aged 2·0–17·9 years with ALL treated with the Nordic Society of Pediatric Haematology and Oncology (NOPHO) ALL2008 non-high-risk protocol. Prospective treatment-related toxicities registered every three-month interval were used. Patients were classified according to sex- and age-adjusted international childhood cut-off values, corresponding to adult body mass index: underweight, <17 kg/m²; healthy weight, 17 to <25 kg/m² overweight 25 to <30 kg/m²; and obese, ≥30 kg/m². Obese children had a higher incidence rate ratio (IRR) for severe toxic events {IRR: 1·55 [95% confidence interval (CI) 1·07–2·50]}, liver and kidney failures, bleeding, abdominal complication, suspected unexpected severe adverse reactions and hyperlipidaemia compared with healthy-weight children. Obese children aged ≥10 years had increased IRRs for asparaginase-related toxicities compared with healthy-weight older children: thromboses [IRR 2·87 (95% CI 1·00–8·21)] and anaphylactic reactions [IRR 7·95 (95% CI 2·15–29·37)] as well as higher risk for truncation of asparaginase [IRR 3·54 (95% CI 1·67–7·50)]. The high prevalence of toxicity and a higher risk of truncation of asparaginase may play a role in the poor prognosis of obese children aged ≥10 years with ALL.

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Series: British journal of haematology
ISSN: 0007-1048
ISSN-E: 1365-2141
ISSN-L: 0007-1048
Volume: 196
Issue: 5
Pages: 1239 - 1247
DOI: 10.1111/bjh.17936
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Funding: Barncancerfonden (Swedish Childhood Cancer Fund) (grantnumbers TJ2018-0093; PR2019-0075, TJ2019-0048).
Copyright information: © 2021 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution andreproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.