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International Journal of Pediatrics
Volume 2015, Article ID 386413, 10 pages
http://dx.doi.org/10.1155/2015/386413
Research Article

Increased Body Mass Index during Therapy for Childhood Acute Lymphoblastic Leukemia: A Significant and Underestimated Complication

1School of Paediatrics and Child Health, The University of Western Australia, Perth, WA 6009, Australia
2Telethon Kids Institute, The University of Western Australia, Perth, WA 6008, Australia
3Department of Endocrinology, Princess Margaret Hospital, Perth, WA 6008, Australia
4Department of Oncology and Haematology, Princess Margaret Hospital, Perth, WA 6008, Australia
5Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA 6009, Australia
6PathWest, Perth, WA 6008, Australia

Received 28 January 2015; Revised 22 April 2015; Accepted 4 May 2015

Academic Editor: Raymond J. Hutchinson

Copyright © 2015 Helen C. Atkinson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI -scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% for females but remained relatively unchanged for males (9.8% to 13.7%, ). Longitudinal analysis using linear mixed-effects identified associations between BMI -scores and time-dependent interactions with sex , disease risk , age , and BMI -score at diagnosis and total dose of steroid during maintenance . Predicted mean BMI -scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL.