A new study reveals the cancer survival rate for obese with Leukemia.
As the prevalence of obesity continues to rise in the United States, scientists are intensifying their investigation into the impact of body weight on health outcomes. Recent research published in Blood Advances sheds light on a potential association between elevated body mass index (BMI) and inferior treatment outcomes for acute lymphoblastic leukemia (ALL) in adolescents and young adults (AYAs).
The study underscores the influence of weight on treatment toxicities and outcomes, emphasizing the need for further exploration of weight’s impact on response to various chemotherapy regimens for ALL.
Obesity has become a pressing public health concern in the United States, affecting around 40% of the population as of 2020. The findings of this study suggest that elevated BMI, indicative of obesity, may have an adverse effect on the response of AYAs to ALL treatment regimens.
Lead author Dr. Shai Shimony, an advanced fellow at the Dana-Farber Cancer Institute, explained, “We have known for roughly fifteen years that obesity affects survival in pediatric patients treated for ALL, and more recently, we are recognizing a similar relationship in adult populations.
“But we wanted more granular data on this, to understand why this correlation exists, and how dependent it is on age.”
The research team gathered data from 388 AYAs aged 15-50 years, with an average age of 24 years, who underwent treatment using Dana-Farber Consortium pediatric regimens for ALL between 2008 and 2021. The researchers examined the relationship between BMI, age, treatment toxicities, and outcomes within the cohort, aiming to identify any correlations or trends.
Among the AYAs included in the study, 53.3% had a normal BMI, while 46.6% were categorized as overweight or obese. Significantly, patients with an overweight or obese BMI exhibited higher rates of non-relapse mortality (11.7% vs. 2.8%), lower event-free survival rates (63% vs. 77% at 4 years), and worse overall survival (64% vs. 83%) compared to those with normal BMIs. Importantly, the study found equivalent overall survival among younger (15-29) and older (30-50) AYAs with normal BMI (83% vs. 85%, respectively), a significant finding as age is often considered an adverse prognostic factor in ALL.
Interestingly, they discovered that the primary factor driving poorer outcomes across the entire cohort was non-relapse mortality rather than disease relapse. In terms of toxicity, patients classified as overweight or obese exhibited more frequent occurrences of elevated liver enzymes and glucose levels (60.7% vs. 42.2% and 36.4% vs. 24.4%, respectively).
In the multivariable model for survival, higher BMI was associated with worse survival, while age showed no association with survival. Elevated triglyceride levels, which indicate the activity of a key chemotherapy medication (asparaginase) included in the regimen, were associated with improved survival. This finding suggests the potential use of this affordable laboratory test as a biomarker for treatment efficacy. However, the researchers caution against interpreting this as an adverse finding.
Dr. Shimony emphasized, “This study highlights the association between elevated BMI and increased treatment-related toxicity, non-relapse mortality, and decreased overall survival in AYAs undergoing treatment for ALL with intensive pediatric regimens.”
Study authors Dr. Daniel DeAngelo and Dr. Marlise Luskin also highlighted the effectiveness of the DFCI regimen in patients aged 18-50 years with normal BMI.
It is important to acknowledge the limitations of this study, including its retrospective nature, the absence of data on measurable residual disease outcomes, and the predominantly white population. Additionally, the investigators emphasize the need for prospective collection of BMI data, as well as other measures of obesity such as waist circumference and waist-to-hip ratio, correlated with outcomes in various treatment contexts, encompassing patients of all ages and incorporating novel therapies.
“Moving forward, we hope that measures of obesity will be considered a vital variable in determining the most suitable treatment regimens for each individual patient,” stressed Dr. Shimony.
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