ArticleCancer2023
Body mass index during maintenance therapy and relapse risk in children with acute lymphoblastic leukemia: A Children's Oncology Group report.
Article in Cancer, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 28 citations in OpenAlex.
- Growth and nutritional outcomes in children during the first year of cancer treatment: a scoping review with implications for child health care in low- and middle-income countries (LMICs).BMJ paediatrics open · 2026Article
- Leveraging Dietary Interventions to Benefit Patients with Hematologic Malignancies and Clonal Hematopoiesis.Nutrients · 2026Review
- Household Poverty and Obesity in Children With Acute Lymphoblastic Leukemia: A Report From COG-AALL03N1.Pediatric blood & cancer · 2026Article
- Opinion: a call for safe therapeutic and gastric interventions for adolescents and young adults with obesity and transplant-indicated leukemia.Frontiers in oncology · 2026Article
- Clinical evidence and biological mechanisms linking obesity to adverse outcomes in pediatric and adolescent acute lymphoblastic leukemia.Frontiers in oncology · 2026Review
- Neighborhood socioeconomic status and overall survival among children with acute lymphoblastic leukemia.Blood advances · 2025Article
- A Novel Approach to Prognostic Factors and Risk Stratification in Pediatric AML: Case Report and Literature Review.International journal of molecular sciences · 2025Review
- Overweight or Obesity and Outcomes in Children With Acute Lymphoblastic Leukemia.JAMA network open · 2025Article
- Body Composition at Diagnosis and Early Response in Pediatric Hodgkin Lymphoma.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025Article
- The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review.Journal of human nutrition and dietetics : the official journal of the British Dietetic Association · 2025Review
- Nutritional intervention as adjuvant therapy for T-cell acute lymphoblastic leukemia.Blood advances · 2024Article
- Longitudinal changes in body mass index, height, and weight in children with acute myeloid leukemia.BMC pediatrics · 2024Article
- Future of Treatment of Adolescents and Young Adults With ALL: A Vision for Collaboration and Equity.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Review
- Maintenance Treatment in Acute Lymphoblastic Leukemia: A Clinical Primer.Indian journal of pediatrics · 2024Review
- Hypoxanthine in the microenvironment can enable thiopurine resistance in acute lymphoblastic leukemia.Frontiers in oncology · 2024Article
- Children's Oncology Group's 2023 blueprint for research: Cancer control and supportive care.Pediatric blood & cancer · 2023Article
- Article
Corrections and comments
- Commented on by
Authors and funding
14 authors at 9 institutions in 1 country.
Funding
Abstract
backgroundObesity at diagnosis of childhood acute lymphoblastic leukemia (ALL) is associated with greater risk of relapse; whether this association extends to obesity during maintenance is unstudied.
methodsThis study used data from AALL03N1 to calculate median body mass index (BMI) for 676 children over 6 consecutive months during maintenance therapy; BMI percentile (BMI%ile) were operationalized as normal/underweight (<85%ile), overweight/obese (85%-98%ile), and extreme obesity (≥99%ile). Hazard of relapse was estimated using multivariable proportional subdistributional hazards regression after adjusting for all relevant demographic and clinical predictors.
resultsMedian age at study enrollment was 6 years and median length of follow-up was 7.9 years. Overall, 43.3% of the cohort was underweight/normal weight, 44.8% was overweight/obese, and 11.8% had extreme obesity. Cumulative incidence of relapse at 4 years from study enrollment was higher among those with extreme obesity (13.6% ± 4.5%) compared to those with underweight/normal weight (9.0% ± 2.1%). Multivariable analysis revealed that children with extreme obesity had a 2.4-fold (95% confidence interval [CI], 1.1-5.0; p = .01) greater hazard of relapse compared to those who were underweight/normal weight. Overweight/obese patients were at comparable risk to those who were underweight/normal weight (hazard ratio, 0.8; 95% CI, 0.4-1.6). Erythrocyte thioguanine nucleotide (TGN) levels were significantly lower among children with extreme obesity compared to those with underweight/normal weight (141.6 vs. 168.8 pmol/8 × 10
conclusionsExtreme obesity during maintenance therapy is associated with greater hazard of relapse in children with ALL. Underlying mechanisms of this association needs further investigation. LAY SUMMARY: Findings from this study demonstrate that extreme obesity during maintenance therapy is associated with a greater hazard of relapse among children with acute lymphoblastic leukemia. We show that children with obesity have lower levels of erythrocyte thioguanine nucleotides even after adjusting for adherence to oral chemotherapy. However, these lower levels do not explain the greater hazard of relapse, paving the way for future studies to explore this association.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.