Many pediatric patients who undergo treatment for acute myeloid leukemia (AML) experience body composition changes during and after completion of treatment, with changes in weight and body mass index (BMI) during therapy and decreased height that persists long-term after treatment is completed, according to the results of a study published in the journal Blood Advances.
There has been increasing interest in treatment-associated obesity among children with acute lymphoblastic leukemia, but there are few studies that have evaluated this effect among pediatric patients with AML. The aim of this study was to characterize the effect of AML treatment on BMI, weight, and height during and after therapy, and how body composition changes may affect outcomes.
This longitudinal study analyzed data from 277 pediatric patients with AML treated at St. Jude in the AML 02 and AML 08 clinical trials between 2002 and 2017. Weight, height, and dietary intake were evaluated at baseline and throughout the clinical trial periods and after treatment completion and were converted to Z-scores. The median follow-up was 6 years.
The median age of the cohort at diagnosis was 9 years (range, 5 days to 21 years), 49.3% of patients were female, and 68.3% were White, 24.7% were Black, and 6.6% were of other race. There were 32.6% of patients who underwent a hematopoietic stem cell transplant. The median baseline Z-scores for BMI was 0.170, weight was 0.193, and height was 0.209.
The proportion of patients who were obese (11.9%), overweight (8.8%), of healthy weight (69.6%), and underweight (9.7%) at baseline remained similar throughout AML treatment. These proportions changed substantially 1 year after treatment completion, with 24.8% obese, 17.8% overweight, 55.4% of healthy weight, and 2.0% underweight.
“This rate represents a doubling from that at diagnosis and exceeds the nationally reported rates, putting survivors at increased risk of metabolic syndrome,” the authors wrote in their report.
At the end of AML treatment, the median Z-scores significantly decreased for weight and height compared with baseline levels, with Z-scores of -0.038 and -0.163, respectively (P <.001 for both). The decrease in height persisted throughout the off-therapy, with a significantly lower Z-score of -0.066 at 5 years after treatment completion (P <.001). In contrast, the Z-scores significantly increased for weight at 0.492 (P =.003) and BMI at 0.911 (P <.001).
Among patients who underwent transplant, the Z-score for height decreased significantly from -0.211 at the time of transplant to a score of -0.617 (P <.001) at 1 year post transplant. Survival outcomes were not associated with baseline BMI or Z-scores.
Changes in weight Z-scores was associated with death during first remission, both for higher (HR, 1.31; 95% CI, 1.01-1.70) and lower Z-scores (HR, 1.97; 95% CI, 1.10-3.53). However, a higher weight Z-score was also associated with a lower incidence of relapsed/refractory disease (HR, 0.82; 95% CI, 0.67-0.99).
A greater risk of gastrointestinal and hepatic toxicities and infection during induction therapy and death during remission was associated with higher weight Z-scores (HR, 2.66; 95% CI, 1.11-6.45).
The authors concluded that these data “revealed a distinct pattern of body composition changes in pediatric patients with AML.” They added that “we suggest that clinicians should not rely on BMI alone as a marker of nutritional status but should also closely monitor weight and height.”
The quality of life of pediatric patients could be improved with “efforts to minimize weight loss during therapy and weight gain after therapy, along with close monitoring and intervention for short stature and supportive care,” the authors said.
Lijima M, Stall M, Wang L, et al. Changes in body mass index, weight, and height in children with acute myeloid leukemia and the associations with outcome. Blood Adv. 2022;6:2824-2834. doi:10.1182/bloodadvances.2021006090