文章：

诊断时体重指数对新诊断急性淋巴细胞白血病患儿临床结局的影响

The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia

原文发布日期：2017-02-17

DOI: 10.1038/bcj.2017.11

类型: Original Article

开放获取: 是

英文摘要：

The impact of body mass index (BMI) at diagnosis on treatment outcome in children with acute lymphoblastic leukemia (ALL) is controversial. We studied 373 children with ALL enrolled on the Total XV study, which prospectively used minimal residual disease (MRD) for risk assignment. MRD on day 19 and at the end of remission induction (day 46), cumulative incidence of relapse/refractory disease (CIR), event-free survival (EFS) and overall survival (OS) were evaluated using sets of four, three and two subgroups based on BMI at diagnosis, along with BMI percentile change during remission induction. Higher BMI was associated with older age and higher treatment risk. There was no association between MRD on days 19 or 46 and BMI for four, three or two BMI subgroups (P>0.1 in all cases), nor was BMI associated with CIR or EFS. Obese patients had worse OS compared with non-obese (P=0.031) due to treatment-related mortality and less salvage after refractory disease or bone marrow relapse. No association between BMI change during remission induction and MRD, CIR, EFS or OS was seen. BMI at diagnosis does not predict poorer response or relapse in a contemporary MRD-directed ALL regimen. Improvements in supportive care and innovative, less-toxic frontline/salvage therapies are needed, especially for obese patients.

摘要翻译： 

诊断时体重指数（BMI）对急性淋巴细胞白血病（ALL）患儿治疗效果的影响尚存争议。我们在Total XV研究中纳入373例ALL患儿，该研究前瞻性采用微小残留病（MRD）进行风险分层。基于诊断时BMI设置的四种、三种及两种亚组，以及缓解期诱导期间BMI百分位变化，评估了第19天与缓解诱导期末（第46天）的MRD、复发/难治性疾病累积发生率（CIR）、无事件生存期（EFS）和总生存期（OS）。较高BMI与年龄较大及治疗风险较高相关。在四种、三种或两种BMI亚组中，第19天或第46天MRD与BMI均无关联（所有情况P>0.1），BMI与CIR或EFS亦无相关性。与非肥胖患者相比，肥胖患者因治疗相关死亡率更高及难治性疾病或骨髓复发后挽救治疗机会更少，总生存期更差（P=0.031）。缓解诱导期间BMI变化与MRD、CIR、EFS或OS均无关联。在现代MRD指导的ALL治疗方案中，诊断时BMI不能预测疗效较差或复发。需要改进支持性护理并创新低毒性的前线/挽救疗法，尤其针对肥胖患者。

原文链接：

The effect of body mass index at diagnosis on clinical outcome in children with newly diagnosed acute lymphoblastic leukemia