Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Cancer. 2018 Nov 1;124(21):4248-4259. doi: 10.1002/cncr.31736. Epub 2018 Oct 25.
Children with acute lymphoblastic leukemia (ALL) have an increased risk of obesity and short stature. To the authors' knowledge, data regarding patients treated on contemporary protocols without cranial irradiation are limited.
Changes in z scores for body mass index (BMI), height, and weight from the time of diagnosis to 5 years off therapy were evaluated using multivariable analysis in 372 children with ALL who were aged 2 to 18 years at the time of diagnosis and were enrolled on the St. Jude Children's Research Hospital Total XV protocol from 2000 through 2007.
The percentage of overweight/obese patients increased from 25.5% at the time of diagnosis to approximately 50% during the off-therapy period. Median BMI z scores increased significantly during glucocorticoid therapy (induction: ∆0.56; 95% confidence interval [95% CI], 0.29-0.64 [P<.001]; and reinduction II: ∆0.22; 95% CI, 0.13-0.49 [P=.001]) and during the first year after therapy (∆0.18; 95% CI, 0.08-0.46 [P=.006]). Among patients who were of healthy weight/underweight at the time of diagnosis, those aged 2 to <10 years at diagnosis had a significantly higher risk of becoming overweight/obese during or after therapy compared with those aged ≥10 years (P=.001). Height z scores declined during treatment and improved after therapy. Being aged 2 to <10 years at the time of diagnosis, being of low-risk status, having a white blood cell count < 50×10 /L at the time of diagnosis, and having negative central nervous system disease were associated with significantly better improvements in z scores for height during the off-therapy period compared with being aged ≥10 years, being of standard-risk/high-risk status, having a white blood cell count ≥ 50×10 /L, and having positive central nervous system disease, respectively.
The results of the current study demonstrate that obesity is prevalent, and height growth, especially in patients with identified risk factors, appears compromised. Multidisciplinary intervention should begin during induction therapy and continue during the off-therapy period.
患有急性淋巴细胞白血病（ALL）的儿童肥胖和身材矮小的风险增加。据作者所知，关于不接受颅照射的当代方案治疗患者的数据有限。
使用多变量分析评估了 372 名年龄在 2 至 18 岁的 ALL 患儿在诊断后 5 年期间的体重指数（BMI）、身高和体重 z 评分变化，这些患儿在 2000 年至 2007 年期间接受了圣裘德儿童研究医院总 XV 方案治疗。
超重/肥胖患儿的比例从诊断时的 25.5%增加到治疗结束时的约 50%。在糖皮质激素治疗期间（诱导期：∆0.56；95%置信区间[95%CI]，0.29-0.64[P<.001]；和再诱导 II 期：∆0.22；95%CI，0.13-0.49[P=.001]）和治疗后第一年，中位数 BMI z 评分显著升高。在诊断时体重健康/体重不足的患者中，与诊断时年龄≥10 岁的患者相比，诊断时年龄为 2 至<10 岁的患者在治疗期间或之后超重/肥胖的风险显著更高（P=.001）。身高 z 评分在治疗期间下降，治疗后改善。诊断时年龄为 2 至<10 岁、低危状态、诊断时白细胞计数<50×10 /L 以及无中枢神经系统疾病与诊断时年龄≥10 岁、中高危状态、白细胞计数≥50×10 /L 和中枢神经系统疾病阳性相比，在治疗结束期间 z 评分对身高的改善有显著差异。
目前的研究结果表明，肥胖是普遍存在的，身高增长，尤其是在有明确危险因素的患者中，似乎受到了影响。多学科干预应在诱导治疗期间开始，并在治疗结束期间继续进行。
