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NUTRITION AND BODY COMPOSITION IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA by Etan Orgel
A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE (CLINICAL AND BIOMEDICAL INVESTIGATIONS) December 2011
Copyright 2011 Etan Orgel
Object Description
| Title | Nutrition and body composition in pediatric acute lymphoblastic leukemia |
| Author | Orgel, Etan |
| Author email | eorgel@chla.usc.edu;eorgel@chla.usc.edu |
| Degree | Master of Science |
| Document type | Thesis |
| Degree program | Clinical and Biomedical Investigations |
| School | Keck School of Medicine |
| Date defended/completed | 2011-12-01 |
| Date submitted | 2011-10-31 |
| Date approved | 2011-10-31 |
| Restricted until | 2012-04-30 |
| Date published | 2012-04-30 |
| Advisor (committee chair) | Mittelman, Steven |
| Advisor (committee member) |
Freyer, David Seeger, Robert |
| Abstract | Intensification of treatment for Acute Lymphoblastic Leukemia (ALL) has improved survival but has also led to large increases in treatment-related toxicity (TRT). Weight and body composition are well-recognized mediators of chronic disease whose impact in childhood cancer is still being determined. Previous studies and pilot data have demonstrated that children with ALL undergo significant changes in body composition during therapy that may have a significant effect on TRT and outcome. ❧ We therefore undertook a two-part investigation into body composition and its effect on TRT in childhood ALL. Children's Oncology Group (COG) CCG-1961 was a large cooperative group clinical trial in high-risk ALL. We conducted a secondary analysis of the study that demonstrated either weight extreme, severely underweight or obese, was associated with increased TRT. Outcome as measured by event-free survival (EFS) was worse in both weight extremes but this did not reach statistical significance on multivariate analysis. The second half of our investigation is ongoing and explores a common complication of ALL therapy. Poor bone health affects approximately one in four children during treatment and also has the potential for long-term sequalae and reduced quality of survival. As Vitamin D insufficiency is prevalent in this population and known to be a key mediator of bone health, we therefore designed a prospective, randomized, double-blinded, placebo-controlled interventional clinical trial of Vitamin D supplementation in the context of body composition. This will also provide an in-depth description of bone metabolism during treatment for ALL that will help identify other targets for future intervention. ❧ These two studies represent only the surface of the likely impact of weight and body composition on TRT in the treatment of childhood ALL and other cancers and further research is required to continue to characterize their effect on different morbidities. |
| Keyword | oncology; acute lymphoblastic leukemia; nutrition |
| Language | English |
| Part of collection | University of Southern California dissertations and theses |
| Publisher (of the original version) | University of Southern California |
| Place of publication (of the original version) | Los Angeles, California |
| Publisher (of the digital version) | University of Southern California. Libraries |
| Provenance | Electronically uploaded by the author |
| Type | texts |
| Legacy record ID | usctheses-m |
| Rights | Orgel, Etan |
| Access conditions | The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given. |
| Repository name | University of Southern California Digital Library |
| Repository address | USC Digital Library, University of Southern California, University Park Campus MC 7002, 106 University Village, Los Angeles, California 90089-7002, USA |
| Repository email | cisadmin@usc.edu |
| Archival file | uscthesesreloadpub_Volume71/etd-OrgelEtan-377.pdf |
Description
| Title | Page 1 |
| Full text | NUTRITION AND BODY COMPOSITION IN PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA by Etan Orgel A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE (CLINICAL AND BIOMEDICAL INVESTIGATIONS) December 2011 Copyright 2011 Etan Orgel |
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