Impact of Initial Body Mass Index (BMI) on Survival Outcome of Patients with Acute Leukemia (AL): Myth or Reality?

Obesity is associated with an increased risk of mortality from cardiovascular causes and from malignancies while meta-analyses have evidenced a significant association between an elevated body mass index (BMI) and the risk to develop certain hematological malignancies including acute myeloid (AML) and acute lymphoid leukemia (ALL). Adipocytes are present in the bone marrow were it promote leukemic cells survival and resistance to treatment through the production of amino acids, free fatty acids, pro-inflammatory adipokines and cytokines. Obesity modifies the pharmacokinetic of numerous drugs while obese patients may be undertreated due to dosage capping based on ideal body weight. In addition, obesity increases the risk of treatment-related complication. Obesity adversely affects outcome in pediatric ALL (Butturini et al, J Clin Oncol 2007) and AML (Inaba et al, Cancer 2012). In contrast two retrospective studies based on the analysis of 63 (Lin et al, Leuk Lymphoma 2012) and 329 cases (Lee et al, Ann Hematol 2012) did not found any significant association between obesity and disease outcome in adult patients treated for AML. Here we have investigated whether the body mass index, determined at the time of diagnosis could impact disease outcome in adult patients treated for acute leukemia (AL).