Changes in bodymass index in long-term survivors of childhood acute lymphoblastic leukemia treated without cranial radiation and with reduced glucocorticoid therapy

Background: Cranial radiation and glucocorticoids are associated with an increase in body mass index (BMI) z-score in survivors of childhood acute lymphoblastic leukemia (ALL). We aimed to investigate the impact of a contemporary treatment protocol that omitted prophylactic cranial radiation and glucocorticoids from the maintenance phase on longitudinal BMI, height, and weight z-scores in children with ALL. Method: We retrospectively studied 184 children with standard-and medium-risk ALL treated without cranial radiation or glucocorticoids. Height, weight, and BMI z-scoreswere collected from diagnosis to 7 years after diagnosis. Longitudinal changes in anthropometric data were compared to diagnosis using separate linear mixed models, adjusting for age, sex, and socioeconomic status (SES). Results: Relative to diagnosis, there was a significant increase in estimated marginal mean BMI z-score during dexamethasone-containing re-induction (1.08, P < 0.001) that persisted throughout intensification (0.85, P < 0.001) and maintenance phases (0.81, P < 0.001), and up to 7 years after diagnosis (0.76, P = 0.002). Height z-scores decreased over the same time (P < 0.001), whereas weight z-scores fluctuated during treatment and declined thereafter (P= 0.007). Ahigher BMI z-score at diagnosis was associated with a younger age (P < 0.001), male sex (P < 0.001), and lower SES (P < 0.001). Conclusions: Children who did not receive cranial radiation or glucocorticoids during maintenance remain at increased risk of treatment-related increases in BMI z-score, which is associated with a loss of height z-score. Interventions designed to mediate this risk should begin early, even while children are on treatment because of the association with cardiovascular risk. Monitoring of survivors of ALL should include anthropometric measures.