Bhat, Nikhil U.


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Purpose: The Purpose of the project was to: Establish a data base for evaluating the problem of obesity in ALL survivors. Measure the frequency of obesity in a population of patients treated at CCMC on Total XV. Evaluate changes in BMI according to key time points during patient's ALL therapy and follow up and observe if there is a trend seen in any variable like ethnicity or gender. Methods: Ninety ALL patients were identified that were diagnosed and treated on the St. Jude Total Therapy XV at Cook Children's Medical Center(CCMC) between the years 2004-2007 and later followed up through August 2012. A database was created to record the measurements of each patient.Later a retrospective observational study to measure the frequency of obesity in a subset of 90 ALL patients treated at CCMC on the Total Therapy XV Protocol was conducted and the risk factors that may have influenced the development of obesity in these ALL survivors were evaluated. Results: The mean BMI for all the patients who were followed from diagnosis to 2 years after end of therapy increased over time. For the obese category, it was observed that the percentage and number of obese patients increased from baseline to at 2 year post therapy. The results of a mixed regression model reveal that there is significant individual variation with respect to BMI changes across time (p=0.0008). Considering the side effects of steroids and anthracyclines, which include weight gain and osteonecrosis, further research is needed to look at the effect of these predictors on BMI. Conclusions: Based on the results and the statistical interpretation, it is observed that this group of childhood ALL survivors show an increase in BMI with time. It is observed that the number of obese and overweight patients has increased from diagnosis to 2 years post therapy in this group. Hence, preventive measures need to be taken to minimize the risk of obesity in childhood ALL survivors. Preventive measures need to be taken at the primary level, secondary level and tertiary level. We need to reduce the number of new cases of obesity in ALL survivors, decrease the number of existing cases of obesity in ALL survivors and prevent the complications related to obesity in ALL survivors who are already obese. It is essential to involve the entire family of a child to take preventive measures related to obesity in ALL survivors