Outcomes in Obese Patients Undergoing Induction Therapy for Acute Leukemia

Obesity continues to be a growing concern in the United States. According to the guidelines published by ASCO in 2012, chemotherapy doses in this patient population should be calculated based on actual body weight. However, the guidelines do not provide guidance for chemotherapy dosing in patients with hematologic malignancies. We conducted a single-center retrospective chart review (from November 2012 to August 2016) to evaluate clinical outcomes in obese versus nonobese patients undergoing induction chemotherapy for newly diagnosed acute leukemia. All chemotherapy doses were calculated based on actual body weight. The primary outcome was rate of complete remission (CR) following induction chemotherapy. Secondary outcomes included time to absolute neutrophil count (ANC) and platelet recovery, the incidence of febrile neutropenia and clinical or microbiological infections, rate of early (0-15 days) and in-hospital mortality, and overall survival at 6 months. The rate of CR was similar between obese patients and non-obese patients diagnosed with AML (60% vs 61.9%; p=0.86) and ALL (87.5% vs 92.8%; p=0.31). Obese patients with AML were more likely to receive re-induction chemotherapy following 14-day bone marrow biopsy (53.3% vs 23.2%; p=0.019). There were no significant differences in secondary outcomes in either group when comparing obese versus non-obese patients. Obese patients with acute leukemia had similar rates of CR compared to non-obese patients following induction chemotherapy. While chemotherapy dosing based on actual body weight did not lead to excessive toxicity in these patients, continued research is needed to determine optimal dosing and long-term outcomes in this patient population.