Razzouk Bassem I, Rose Susan R, Hongeng Suradej, Wallace Dana, Smeltzer Matthew P, Zacher Margie, Pui Ching-Hon, Hudson Melissa M
Department of Hematology-Oncology, St Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, TN 38105-2794, USA.
J Clin Oncol. 2007 Apr 1;25(10):1183-9. doi: 10.1200/JCO.2006.07.8709.
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.
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.
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.
BMI weight category at diagnosis, rather than type of CNS treatment received, predicted adult weight in long-term survivors of childhood hematologic malignancies.
我们评估了三种中枢神经系统定向治疗方案之一对急性淋巴细胞白血病（ALL）或淋巴细胞淋巴瘤患儿体重指数（BMI）的长期影响，这三种治疗方案分别是：鞘内注射甲氨蝶呤联合静脉高剂量甲氨蝶呤（1 g/m²）、鞘内注射甲氨蝶呤联合18 Gy颅脑放疗、鞘内注射甲氨蝶呤联合24 Gy颅脑放疗。
1979年至1984年间，456例新诊断的ALL和淋巴瘤患儿被纳入田纳西州孟菲斯市圣裘德儿童研究医院的一项单一方案。在诊断时、治疗期间、治疗结束时以及此后大约每6至12个月测量422例患儿的身高和体重。在分析时已达到成人身高的患者（n = 248）根据其BMI、BMI百分位数或根据年龄的身长体重百分位数进行体重分类。
超重或肥胖幸存者的总体百分比接近美国普通人群中的流行率。诊断时年龄较小（<6岁）和超重/肥胖是成人身高时肥胖的最佳预测因素。接受放疗的儿童与未接受放疗的儿童之间，以及接受18 Gy或24 Gy颅脑放疗的患者之间，BMI增加率无显著差异。
诊断时的BMI体重分类，而非所接受的中枢神经系统治疗类型，可预测儿童血液系统恶性肿瘤长期幸存者的成人体重。
