Excess body weight at diagnosis is associated with inferior ALL outcomes in male adolescents in the ALL-BFM 2000 study

Body weight at diagnosis may influence outcomes in childhood acute lymphoblastic leukemia (ALL), although current evidence remains conflicting. Both, underweight and overweight/obesity at diagnosis can negatively affect outcomes. Here, we present data from the ALL-BFM 2000 trial on excess body weight at diagnosis and inferior outcome, especially among male patients aged ≥10 years with ALL. We analyzed 3920 patients with B-cell precursor (BCP)-ALL and 674 patients with T-cell ALL (T-ALL), aged 1 to 17 years. Outcome was assessed by weight category (underweight, normal weight, and overweight/obesity) and sex, age, or risk group. We found that patients aged ≥10 years who were overweight/obese at diagnosis had a significantly worse event-free survival (EFS; BCP-ALL, 63.6%; T-ALL, 65.8%) than patients with normal weight (BCP-ALL, 77.8%; T-ALL, 81.2%) or those who were underweight (BCP-ALL, 77.9%; T-ALL, 83.8%). Interestingly, sex critically determined outcome in patients ≥10 years because especially male patients with overweight/obesity at diagnosis experienced a significantly shorter EFS (BCP-ALL, 54.9%; T-ALL, 62.7%) than patients with normal weight (BCP-ALL, 81.9%; T-ALL, 78.3%) of this age group. Overweight/obesity at diagnosis was identified as independent negative prognostic marker in the group of male (hazard ratio [HR], 2.23) but not female (HR, 1.04) patients ≥10 years with ALL. Male patients ≥10 years with overweight/obesity classified as medium risk or high risk by minimal residual disease showed a higher cumulative incidence of relapse or death, respectively. Our findings suggest that male patients aged ≥10 years with overweight/obesity represent a particularly vulnerable group of patients with ALL who are at increased risk of relapse or death. This trial was registered at www.clinicaltrials.gov as NCT00430118.