Body mass index associated with childhood and adolescent high-risk B-cell acute lymphoblastic leukemia risk: A Children’s Oncology Group report

Taumoha Ghosh, Michaela Richardson, Peter M. Gordon, Justin R. Ryder, Logan G. Spector, Lucie M. Turcotte

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Obesity is a risk factor for many adulthood cancers, but its role in childhood, adolescent, and young adult (AYA) cancer is unknown. Childhood and AYA acute lymphoblastic leukemia (ALL) incidence and obesity prevalence have shown concurrent increases. We sought to identify whether obesity may be a risk factor for childhood and AYA ALL. Methods: Characteristics from individuals with ALL, aged 2-30 years, diagnosed 2004-2017 and treated on Children's Oncology Group (COG) protocols with available pre-treatment anthropometric data (N = 4726) were compared to National Health and Nutrition Examination Survey controls (COG AALL17D2). Body mass index (BMI) was defined using standard CDC definitions. Multivariate conditional logistic regression assessed associations between BMI and ALL with additional analyses stratified by sex and race/ethnicity. Results: Among cases (72% high-risk (HR) B-ALL, 28% T-ALL), 5% had underweight, 58% normal weight, 17% overweight, and 20% obesity. Underweight (OR 2.11, 95% CI 1.56-2.85) and obesity (OR 1.32, 95% CI 1.15-1.53) were associated with B-ALL diagnosis. Specifically, obesity was associated with B-ALL among males (OR 1.57, 95% CI 1.30-1.91) and Hispanic children (OR 1.78, 95% CI 1.39-2.29). Obesity was also associated with central nervous system (CNS) involvement. Conclusion: Pre-treatment obesity is associated with HR B-ALL among males and Hispanics, as well as with CNS involvement, suggesting common physiology between obesity and leukemogenesis. An association between underweight and ALL was confirmed, likely due to cancer-associated wasting. These results have important public health implications for obesity prevention and treatment in children and adolescents to reduce cancer risk.

Original languageEnglish (US)
Pages (from-to)6825-6835
Number of pages11
JournalCancer medicine
Issue number18
StatePublished - Sep 1 2020

Bibliographical note

Funding Information:
Funding Contributions: This work was supported by the University of Minnesota Department of Pediatrics Vikings Award and by a grant from the National Cancer Institute (K08CA234232 [LMT]).

Funding Information:
The authors thank the University of Minnesota Department of Pediatrics and the National Cancer Institute for providing funding support for this study. The authors thank the Children's Oncology Group for providing access to previously collected data used in this study. We would like to acknowledge Jeannette M. Sample, MPH for her assistance in providing additional statistical analysis and her contributions to this paper.

Publisher Copyright:
© 2020 The Authors. Cancer Medicine published by John Wiley & Sons Ltd

Copyright 2020 Elsevier B.V., All rights reserved.


  • childhood ALL
  • obesity
  • risk factors


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