Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
Hematology Department, Rabin Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Blood Adv. 2023 Sep 26;7(18):5234-5245. doi: 10.1182/bloodadvances.2023009976.
Adolescent and young adults (AYAs) with acute lymphoblastic leukemia (ALL) treated with asparaginase-containing pediatric regimens are commonly overweight or obese. We studied the association of body mass index (BMI) on outcomes of 388 AYAs aged 15 to 50 years treated on Dana-Farber Cancer Institute (DFCI) consortium regimens (2008-2021). BMI was normal in 207 (53.3%) and overweight/obese in 181 (46.7%). Patients who were overweight or obese experienced higher nonrelapse mortality (NRM; 4-year, 11.7% vs 2.8%, P = .006), worse event-free survival (4-year, 63% vs 77%, P = .003), and worse overall survival (OS; 4-year, 64% vs 83%, P = .0001). Because younger (aged 15-29 years) AYAs more frequently had a normal BMI (79% vs 20%, P < .0001), we conducted separate analyses in each BMI group. We found excellent OS among younger and older (30-50 years) AYAs with normal BMI (4-year OS, 83% vs 85%, P = .89). Conversely, in AYAs who were overweight/obese, worse outcomes were seen in older AYAs (4-year OS, 55% vs 73%, P = .023). Regarding toxicity, AYAs who were overweight/obese experienced higher rates of grade 3/4 hepatotoxicity and hyperglycemia (60.7% vs 42.2%, P = .0005, and 36.4% vs 24.4%, P = .014, respectively) but had comparable rates of hypertriglyceridemia (29.5% vs 24.4%, P = .29). In a multivariable analysis, higher BMI was associated with worse OS, hypertriglyceridemia was associated with improved OS, and age was not associated with OS. In conclusion, among AYAs treated on DFCI Consortium ALL regimens, elevated BMI was associated with increased toxicity, increased NRM, and decreased OS. The deleterious effect of elevated BMI was more pronounced in older AYAs.
接受含 asparaginase 的儿科方案治疗的青少年和年轻成人 (AYA) 通常超重或肥胖。我们研究了 388 名年龄在 15 至 50 岁的 AYA 在 Dana-Farber 癌症研究所 (DFCI) 联盟方案治疗下的体重指数 (BMI) 对结局的影响 (2008-2021 年)。207 名患者 BMI 正常 (53.3%)，181 名患者超重/肥胖 (46.7%)。超重或肥胖的患者非复发死亡率 (NRM；4 年，11.7% vs 2.8%，P =.006)、无事件生存 (EFS；4 年，63% vs 77%，P =.003) 和总生存 (OS；4 年，64% vs 83%，P =.0001) 更差。因为年轻的 (15-29 岁) AYA 更常具有正常的 BMI (79% vs 20%，P <.0001)，我们在每个 BMI 组中进行了单独的分析。我们发现年轻和年长 (30-50 岁) AYA 的正常 BMI 有极好的 OS(4 年 OS，83% vs 85%，P =.89)。相反，在超重/肥胖的 AYA 中，年长的 AYA 预后更差 (4 年 OS，55% vs 73%，P =.023)。关于毒性，超重/肥胖的 AYA 更易发生 3/4 级肝毒性和高血糖 (60.7% vs 42.2%，P =.0005，和 36.4% vs 24.4%，P =.014，分别)，但高脂血症的发生率相似 (29.5% vs 24.4%，P =.29)。在多变量分析中，较高的 BMI 与较差的 OS 相关，高甘油三酯血症与改善的 OS 相关，而年龄与 OS 无关。总之，在接受 DFCI 联盟 ALL 方案治疗的 AYA 中，BMI 升高与毒性增加、NRM 增加和 OS 降低相关。BMI 升高的有害影响在年长的 AYA 中更为明显。
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