Overweight after treatment for acute lymphoblastic leukemia in children

Objective: To determine the prevalence of overweight in childhood acute lymphoblastic leukaemia (ALL) survivors and to assess the relation between overweight and age at diagnosis, gender or treatment with cranial irradiation (CI) and/or corticosteroids. Patients and methods: Body mass index (BMI) was assessed in patients in continuous complete remission of ALL who were diagnosed between 1972 and 1993 and who were treated according to the DCLSG protocols ALL 2, 3A, 5-8 or the local ALL high-risk (GronHR) protocol. Patients were divided into three treatment groups, based on treatment with or without CI and duration of corticosteroids; group I: CI and intermittent corticosteroids for two years (n = 77); group 2: intermittent corticosteroids for two years (n = 24); group 3: two courses of corticosteroids for four weeks each (n = 47). Prevalences of overweight were compared between groups, related to gender and age at diagnosis and were compared to the growth diagrams from the Fourth Dutch Nationwide Survey 1997. Results: Until five years post-diagnosis more overweight was demonstrated in group 2 survivors; afterwards we found no differences between groups. The prevalence of overweight in boys surviving more than five yeas after diagnosis was 17.1% at age 10 and 16.7% at age 15 (Fourth Dutch Nationwide Survey respectively 7.8%; chi square p = 0.01 and 7.7%; p = 0.07), in girls 24.4% at age 10 and 28.0% at age 15 (Fourth Dutch Nationwide Survey respectively 11.8%; p = 0.03 and 9.4%; p < 0.01). Overweight correlated with age at diagnosis younger than four years but not with gender. Conclusion: Childhood ALL survivors are at high risk for overweight, irrespective of CI and duration of corticosteroid treatment.