Obesity, Emaciated BMI Associated With Poor Prognosis in Pediatric B-Cell Non-Hodgkin Lymphoma

In a study published in Cancer, investigators determined that children and adolescents with high-grade mature B-cell non-Hodgkin lymphoma (HG B-NHL) who had obesity or emaciated body mass index (BMI) had a poorer prognosis than those who had normal or overweight BMI.¹

Obesity can lead to poor outcomes in children with cancer. © yuriygolub | stock.adobe.com

Disease progression or recurrence occurs in about 20% of patients with HG B-NHL; even after treatment such as stem cell transplantation or salvage chemotherapy, patients with relapsed or refractory disease have a 5-year overall survival (OS) rate of 30%. This data highlights the need to utilize prognostic factors to identify patients who could benefit from treatment.¹

Given the limited prognostic factors currently used in the risk stratification of HG B-NHL, the investigators sought to examine BMI and assess the predictive value for pediatric HG B-NHL. Obesity has been shown to promote the growth and spread of tumors in a litany of cancers, including leukemia and gastrointestinal cancers. Furthermore, those with emaciated BMI is a critical factor leading to adverse effects and mortality in patients with cancer.^1,2,3

Primary end points of the study were event-free survival (EFS) and OS. A total of 435 patients with HG B-NHL were enrolled in the study, with the median age at diagnosis being 7.4 years. These patients were stratified into normal, overweight, obese, and emaciated BMI groups, and had 329 (75.6%), 46 (10.6%), 13 (3.0%), and 47 (10.8%), respectively.¹

Median follow-up time was 67.0 months; the 5-year EFS and OS rates of the entire group were 89.3% ± 1.5% and 92.4% ± 1.3%, respectively. In terms of patients in each BMI group, 5-year EFS rates were 89.5% ± 1.7% for normal, 95.6% ± 3.1% overweight, 76.2% ± 12.1% obese, and 85.1% ± 5.2% emaciated.¹

Additionally, the 5-year OS rates for patients with normal, overweight, obese, and emaciated BMI were 93.1% ± 1.4%, 97.7% ± 2.2%, 84.6% ± 10.0%, and 84.5% ± 5.4%, respectively. The investigators noted that the 5-year OS rate for those with emaciated BMI was worse than those with normal or overweight BMI.¹

Studies such as these are important given the widespread presence of pediatric obesity. In a review conducted by Orsi et al., they found from a national survey a tripling of the prevalence of BMI of at least 95% among United States school-age adolescents and children in the last 3 decades.⁴

Correspondingly, the current incidence of overweight, obesity, and malnutrition in a trial of Chinese adolescents and children was over 30%. These results are just a portion of the data sounding the alarm on this public health crisis, as abnormal BMI becomes increasingly common due to unhealthy lifestyles.⁵

Obesity can induce myriad changes in the body that lead to poor prognoses, including changes in the levels of leptin, adiponectin, steroid hormones, and insulin-like growth factor-1. These changes, in turn, can alter the nutritional environment of tumors, creating an environment conducive to the progression and initiation of tumors.¹

For patients with overweight BMI, the investigators made an interesting discovery: their prognosis was excellent. They noted that the BMI of overweight patients could gradually approach normal levels due to the weight loss associated with chemotherapy.¹

Some limitations of the study were acknowledged. The investigators pointed out that the trial was retrospective, so study bias could not be excluded. Additionally, there are many unaccounted variables that could provide more insight into why these factors are connected to poor cancer outcomes. They determined that a larger sample size will be necessary to validate their results.¹

“BMI at diagnosis should be included in the risk stratification of HG B-NHL for precise stratification and treatment,” the study authors concluded.¹

REFERENCES

1. Zeng C, Wei Z, Huang J, et al. Effect of body mass index on the prognosis of children and adolescents with high-grade mature B-cell non-Hodgkin lymphoma. Cancer. 2024. doi:10.1002/cncr.35536

2. Antrim A. Obesity, overweight associated with worse outcomes in leukemia. Pharmacy Times. Published July 12, 2023. Accessed September 5, 2024. https://www.pharmacytimes.com/view/obesity-overweight-associated-with-worse-outcomes-in-leukemia

3. Hunter E. Overweight, obese BMI associated with increased risk of gastrointestinal cancer. Pharmacy Times. Published May 26, 2023. Accessed September 5, 2024. https://www.pharmacytimes.com/view/obesity-overweight-associated-with-worse-outcomes-in-leukemia

4. Orsi CM, Hale DE, Lynch JL. Pediatric obesity epidemiology. Current Opinion in Endocrinology, Diabetes, and Obesity. 2011;18(1):14-22. doi:10.1097/MED.0b013e3283423de1

5. Hu X, Jiang H, Wang H, et al. Intraindividual double burden of malnutrition in Chinese children and adolescents aged 6-17 years: evidence from the China Health and Nutrition Survey 2015. Nutrients. 2021;13(9):3097. doi:10.3390/nu13093097