Obesity is known to negatively impact survival outcomes in young people with leukaemia, with these patients 50% more likely to relapse after treatment. Attempting to improve these outcomes, the IDEAL trial has recently shown that reducing caloric intake by 10% and adopting a moderate exercise program can result in 70% less leukaemic cells after one month of chemotherapy. The rationale of this study comes from the fact that lingering leukaemic cells are found more often in the bone marrow of overweight patients, resulting in a higher risk of relapse.
The study enrolled 40 patients between the ages of 10 and 21 with B-cell acute lymphoblastic leukaemia. These patients received dietary and exercise planning from dieticians and physiotherapists, with this intervention conducted only during the 4-week induction phase of chemotherapy. Although planning was individualised to each patient, the goal of dietary planning was to reduce calorie intake by a minimum of 10%, with the goal of exercise planning being a target of 200 minutes of moderate exercise per week.
The results of this prospective study were encouraging, finding that the intervention reduced fat mass in overweight and obese patients (P= 0.02), resulting less insulin resistance and an increase in the hormone adiponectin- a hormone involved in the regulation of fatty acid breakdown and glucose regulation. Importantly, this resulted in a significant reduction in the risk of minimum residual disease (OR[95%CI]: 0.30[0.09-0.92], P= 0.02).
“This is the first trial to test a diet-and-exercise intervention to improve treatment outcomes from a childhood cancer,” said Dr. Etan Orgel, principal investigator. “This is an exciting proof-of-concept, which may have greater implications for other cancers as well.” Moving forward, the research team hopes to enrol a larger, multicentre cohort in a randomised setting.
Orgel E et al., Caloric and nutrient restriction to augment chemotherapy efficacy for acute lymphoblastic leukemia: the IDEAL trial. Blood Adv. 2021. 5;(7): 1853-1861.