University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Clinical and Translational Sciences Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
Pediatr Blood Cancer. 2019 Feb;66(2):e27515. doi: 10.1002/pbc.27515. Epub 2018 Oct 26.
Obesity correlates with adverse events (AEs) in children with acute myelogenous leukemia and during maintenance therapy for acute lymphoblastic leukemia (ALL). Less is known about AEs in obese ALL patients during pre-maintenance chemotherapy. We evaluated the relationship between obesity (body mass index (BMI) ≥ 95th percentile) and AEs during pre-maintenance chemotherapy in pediatric patients with ALL.
One hundred fifty-five pediatric ALL patients diagnosed at a single institution between 2006 and 2012 were retrospectively evaluated for infections, treatment-requiring hypertension, insulin-requiring hyperglycemia, pancreatitis, pediatric intensive care unit admissions, sepsis, febrile neutropenia (FN) admissions, thrombosis, hepatotoxicity, and nephrotoxicity. Univariate and multivariable analyses compared proportions of obese versus nonobese patients experiencing AEs.
AEs occurring significantly more frequently in obese patients by univariate analysis included treatment-requiring hypertension (17.5% vs 6.1%; OR, 3.27; 95% CI, 1.1-10.0, P = 0.0497) and insulin-requiring hyperglycemia (25.0% vs 11.3%; OR, 2.62; 95% CI, 1.04-6.56, P = 0.04). Obese patients had greater incidence rates for recurrent admission-requiring infections (incidence rate ratio (IRR) 1.64; 95% CI, 1.08-2.48, P = 0.02) and recurrent FN admissions (IRR, 1.53; 95% CI, 1.10-2.12, P = 0.01). Accounting for combined age and NCI risk status, obesity was a risk factor for treatment-requiring hypertension (OR, 3.90; 95% CI, 1.19-12.76, P = 0.02), insulin-requiring hyperglycemia (OR, 3.92; 95% CI, 1.39-11.05, P = 0.01), and FN admission (OR, 2.92; 95% CI, 1.27-6.73, P = 0.01).
During pre-maintenance chemotherapy for ALL, obesity is a risk factor for the development of hypertension, hyperglycemia, and FN admissions. This research provides implications for augmented preventive and supportive care guidelines in obese ALL patients.
肥胖与儿童急性髓细胞性白血病（acute myelogenous leukemia，AML）和急性淋巴细胞白血病（acute lymphoblastic leukemia，ALL）维持治疗期间的不良事件（adverse events，AEs）相关。肥胖 ALL 患者在维持化疗前发生 AEs 的情况知之甚少。本研究评估了肥胖（体重指数（body mass index，BMI）≥第 95 百分位数）与 ALL 患儿维持化疗前化疗期间 AEs 的关系。
对 2006 年至 2012 年在单机构诊断的 155 例 ALL 患儿进行回顾性评估，以了解感染、需要治疗的高血压、需要胰岛素的高血糖、胰腺炎、儿科重症监护病房（pediatric intensive care unit，PICU）入院、败血症、发热性中性粒细胞减少症（febrile neutropenia，FN）入院、血栓形成、肝毒性和肾毒性。单变量和多变量分析比较了肥胖和非肥胖患者发生 AEs 的比例。
单变量分析显示，肥胖患者发生的 AEs 显著更多，包括需要治疗的高血压（17.5% vs 6.1%；比值比（odds ratio，OR）3.27；95%置信区间（confidence interval，CI）1.1-10.0，P=0.0497）和需要胰岛素的高血糖（25.0% vs 11.3%；OR 2.62；95% CI 1.04-6.56，P=0.04）。肥胖患者的再入院感染（再入院率比（incidence rate ratio，IRR）1.64；95% CI 1.08-2.48，P=0.02）和再 FN 入院（IRR 1.53；95% CI 1.10-2.12，P=0.01）发生率更高。在考虑年龄和 NCI 风险状态的综合因素后，肥胖是需要治疗的高血压（OR 3.90；95% CI 1.19-12.76，P=0.02）、需要胰岛素的高血糖（OR 3.92；95% CI 1.39-11.05，P=0.01）和 FN 入院（OR 2.92；95% CI 1.27-6.73，P=0.01）的危险因素。
在 ALL 维持化疗前，肥胖是高血压、高血糖和 FN 入院的危险因素。本研究为肥胖 ALL 患者提供了更具针对性的预防和支持性治疗指南。
