In adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL), being overweight or obese was associated with lower survival rates in a recent study, in addition to worse rates of certain toxicities. The study’s results were reported in the journal Blood Advances.1

“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,” said lead study author Shai Shimony, MD, of Dana-Farber Cancer Institute in Boston, Massachusetts, in a news release. “But we wanted more granular data on this, to understand why this correlation exists, and how dependent it is on age.”2

The study included AYAs with ALL who were receiving asparaginase-containing pediatric treatment regimens. In this study population, Dr Shimony and colleagues analyzed possible relationships between body mass index (BMI) and outcomes in patients. Patients were categorized by having a BMI corresponding to being overweight/obese, compared with not being overweight/obese. Overweight or obese categories using BMI were set based on age groups.1

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The analysis included 388 patients, and they had a median age of 24 years (range, 15-50). Among these patients, BMI at diagnosis was considered normal in 53.3%, while 46.7% of patients were considered overweight or obese. The median study follow-up time was 5.5 years.

Survival outcomes were generally worse for patients who were overweight or obese in this study. The 4-year cumulative incidence of non-relapse mortality was 11.7% in these patients, compared with 2.8% in patients who were not overweight or obese (P =.006). The 4-year event-free survival rates were 63% in overweight/obese patients and 77% in the other patients (P =.003). Overall survival (OS) at 4 years was also worse for overweight/obese patients (64%), compared with those who were not overweight/obese (83%; P =.0001).

Additionally, grade 3 or 4 hepatoxicity was reported at a higher rate in patients who were overweight/obese (60.7%) than in the other patients (42.2%; P =.0005). Grade 3 or 4 hyperglycemia was reported at rates of 36.4% in patients who were overweight/obese and 24.4% in other patients (P =.014). Hypertriglyceridemia rates did not significantly differ between groups (29.5%, versus 24.4%, respectively; P =.29).

A multivariable analysis showed a significant relationship between higher BMI and poorer OS, while hypertriglyceridemia was linked to improved OS. Age did not show an association with OS in this multivariable analysis.

“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,” Dr Shimony explained in the news release.2

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


  1. Shimony S, Flamand Y, Valtis YK, et al. Effect of BMI on toxicities and survival among adolescents and young adults treated on DFCI Consortium ALL trials. Blood Adv. Published online July 11, 2023. doi:10.1182/bloodadvances.2023009976
  2. Obesity and high weight linked to adverse outcomes in leukemia treatment. News release. American Society of Hematology; July 11, 2023. Accessed July 11, 2023.