Weight at diagnosis: an ally or an obstacle?

#Leukemia  #Cancer  #BMI  #Obesity  #Malnutrition  #Oncology


Obesity and malnutrition in children are increasing worldwide. Recent data suggest that these factors may influence the progression of many diseases, including pediatric cancers. Among them, acute leukemia—comprising acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML)—remains the most common form. While therapeutic advances have significantly improved survival rates, some factors influencing treatment response remain poorly understood.

Although body mass index (BMI) is recognized as a risk factor in several adult cancers, its impact on the prognosis of pediatric leukemias remains underexplored. Obesity, for instance, may induce chronic inflammation and alter chemotherapy pharmacokinetics, whereas malnutrition may weaken patients by reducing immune reserves and treatment tolerance.

This study aims to analyze the influence of BMI at diagnosis on the clinical outcomes and survival of children with acute leukemia by assessing its effects on mortality, event-free survival, and relapse risk.

Read next: ALL: a constantly evolving battle

Weight and leukemia: a risky duo?

This study is based on a meta-analysis of 17 studies involving pediatric leukemia patients. The data were analyzed to assess the impact of BMI at diagnosis on three key criteria: overall survival, event-free survival, and relapse risk.

The analysis reveals that both obese and underweight children have an increased risk of mortality compared to those with a normal BMI.

Findings indicate that underweight children have an increased mortality risk with a hazard ratio (HR) of 1.07, while obesity is associated with an HR of 1.42. Event-free survival is also reduced, with an HR of 1.10 for underweight children and 1.34 for obesity. However, no significant differences were observed in relapse risk, regardless of weight status.

These results suggest that BMI at diagnosis may influence treatment response, highlighting the importance of appropriate nutritional management from the start of the therapeutic journey.

BMI: a key prognostic factor?

Pediatric acute leukemia is the most common childhood cancer. Despite significant therapeutic advances that have improved survival rates, several factors influencing treatment response remain poorly understood. BMI could play a key role in disease progression. While obesity promotes chronic inflammation and metabolic alterations, malnutrition weakens immune defenses and reduces treatment tolerance. However, the precise impact of these imbalances on leukemia survival and progression remains unclear.

This study aims to assess the influence of BMI at diagnosis on overall survival, event-free survival, and relapse risk in children with leukemia.

The findings show that obese or underweight children at diagnosis have an increased risk of mortality and lower event-free survival compared to patients with a normal BMI. However, no link was found between BMI and relapse risk.

Nonetheless, major limitations persist. Variations in BMI definitions across studies complicate result interpretation, while socioeconomic factors and differences in patient management were not uniformly analyzed. Further research is needed to better understand the impact of nutritional status on treatment response. Integrating nutritional care from the time of diagnosis could not only improve survival in children with leukemia but also reduce complications associated with weight imbalances.

Read next: Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021