Obesity in Adult Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

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Abstract
Purpose: To determine whether adult survivors (≥ 18 years of age) of childhood acute lymphoblastic leukemia (ALL) are at increased risk for obesity and to assess patient and treatment variables that influence risk. Patients and Methods: A retrospective cohort of participants of the Childhood Cancer Survivor Study was used to compare 1,765 adult survivors of childhood ALL to 2,565 adult siblings of childhood cancer survivors. Body-mass index (BMI; kilograms per square meter), calculated from self-reported heights and weights, was used to determine the prevalence of being overweight (BMI, 25–29.9) or obese (BMI ≥ 30.0). Polytomous logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for being overweight or obese among ALL survivors relative to the sibling control group. Results: The age- and race-adjusted OR for being obese in survivors treated with cranial radiation doses ≥ 20 Gy in comparison with siblings was 2.59 for females (95% CI, 1.88 to 3.55; P < .001) and 1.86 for males (95% CI, 1.33 to 2.57; P < .001). The OR for obesity was greatest among females diagnosed at 0 to 4 years of age and treated with radiation doses ≥ 20 Gy (OR, 3.81; 95% CI, 2.34 to 5.99; P < .001). Obesity was not associated with treatment consisting of chemotherapy only or with cranial radiation doses of 10 to 19 Gy. Conclusion: Cranial radiotherapy ≥ 20 Gy is associated with an increased prevalence of obesity, especially in females treated at a young age. It is imperative that healthcare professionals recognize this risk and develop strategies to enhance weight control and encourage longitudinal follow-up.