Mortality in overweight and children with acute myeloid underweight leukemia
Mortality in overweight and children with acute myeloid underweight leukemia
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DOI：
10.1001/jama.293.2.203
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发表时间：
2005-01-12
影响因子：
120.7
通讯作者：
Alonzo, TA
中科院分区：
文献类型：
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作者：
Lange, BJ;Gerbing, RB;Alonzo, TA
目前儿童急性髓性白血病（AML）的治疗治愈率约为一半。在另一半患者中，大多数死于白血病，但5%至15%死于治疗相关的并发症。患有急性髓性白血病的超重儿童似乎经历了过多的危及生命和致命的毒性。体重如何影响小儿急性髓性白血病的预后尚不清楚。目的比较诊断时体重过轻（体重指数[BMI]小于或等于第10个百分位数）、超重（体重指数大于或等于第95个百分位数）或中等体重（体重指数= 11 -94个百分位数）的急性髓系白血病儿童的生存率。设计、环境和参与者：1996年8月30日至2002年12月4日，儿童癌症组2961（一项针对先前未经治疗的AML的国际合作组3期试验），对768名1至20岁儿童和年轻人的BMI和生存率进行回顾性评价。数据收集至2004年1月9日，中位随访31个月（范围0-78个月）。主要结局指标生存和治疗相关死亡率的风险比（hr）。结果768例患者中体重过轻84例（10.9%），超重114例（14.8%）。在调整了年龄、种族、白细胞计数、细胞遗传学和骨髓移植等潜在的混杂变量后，与中等体重患者相比，体重过轻的患者生存的可能性更小（HR, 1.85； 95%置信区间[CI]， 1.19-2.87； P= 0.006），更容易出现治疗相关的死亡率（HR, 2.66; 95% Cl, 1.38-5.11； P= 0.003）。同样，超重患者生存的可能性更低（HR, 1.88; 95% Cl, 1.25-2.83； P= 0.002），治疗相关死亡率更高（HR, 3.49; 95% Cl, 1.99-6.10； P= 0.002）
Context Current treatment for acute myeloid leukemia (AML) in children cures about half the patients. Of the other half, most succumb to leukemia, but 5% to 15% die of treatment-related complications. Overweight children with AML seem to experience excess life-threatening and fatal toxicity. Nothing is known about how weight affects outcomes in pediatric AML.Objective To compare survival rates in children with AML who at diagnosis are underweight (body mass index [BMI] less than or equal to10th percentile), overweight (BMI greater than or equal to95th percentile), or middleweight (BMI = 11th-94th percentiles).Design, Setting, and Participants Retrospective review of BMI and survival in 768 children and young adults aged 1 to 20 years enrolled in Children's Cancer Group-2961, an international cooperative group phase 3 trial for previously untreated AML conducted August 30, 1996, through December 4, 2002. Data were collected through January 9, 2004, with a median follow-up of 31 months (range, 0-78 months).Main Outcome Measures Hazard ratios (HRs) for survival and treatment-related mortality.Results Eighty-four of 768 patients (10.9%) were underweight and 114 (14.8%) were overweight. After adjustment for potentially confounding variables of age, race, leukocyte count, cytogenetics, and bone marrow transplantation, compared with middleweight patients, underweight patients were less likely to survive (HR, 1.85; 95% confidence interval [CI], 1.19-2.87; P=.006) and more likely to experience treatment-related mortality (HR, 2.66; 95% Cl, 1.38-5.11; P=.003). Similarly, overweight patients were less likely to survive (HR, 1.88; 95% Cl, 1.25-2.83; P=.002) and more likely to have treatment-related mortality (HR, 3.49; 95% Cl, 1.99-6.10; P