Effect of BMI on Toxicities and Survival Among Adolescents and Young Adults Treated on DFCI Consortium ALL Trials.

Adolescent and young adults (AYAs) with acute lymphoblastic leukemia (ALL) treated with asparaginase-containing pediatric regimens commonly are overweight or obese. We studied the association of body mass index (BMI) on outcomes of 388 AYAs aged 15-50 years treated on Dana-Farber Consortium regimens (2008-2021). Body mass index (BMI) was normal in 207 (53.3%) and overweight/obese in 181 (46.7%). Patients with who were overweight or /obese experienced higher non-relapse mortality (NRM, 4-year 11.7% vs. 2.8%, p=0.006), worse event-free survival (4-year 7763% vs. 6377% p=0.003), and worse overall survival (OS, 4-year, 64% vs.83%, p=0.0001). As younger (15-29 years) AYAs more frequently had normal BMI (79% vs. 20%, p<0.0001), we conducted separate analyses in each BMI group. We found excellent OS among younger and older (30-50 years) AYAs with normal BMI (4-year OS, 83% vs. 85%, p=0.89). Conversely, in AYAs with who were overweight/obese BMI, worse outcomes were seen in older AYAs (4-year OS, 55% vs. 73%, p=0.023). Regarding toxicity, AYAs with who were overweight/obese BMI experienced higher rates of grade III/IV hepatotoxicity and hyperglycemia (60.7% vs. 42.2%, p=0.0005, and 36.4% vs. 24.4%, p=0.014, respectively), but had comparable rates of hypertriglyceridemia (29.5% vs. 24.4%, p=0.29). In a multivariable analysis, higher BMI was associated with worse OS, hypertriglyceridemia was associated with improved OS, and age was not associated with OS. In conclusion, among AYAs treated on Dana-Farber Consortium ALL regimens, elevated BMI wais associated with increased toxicity, increased NRM, and decreased OS. The deleterious effect of elevated BMI wais more pronounced in older AYAs.