By limiting calories and increasing physical activity, even slightly, in children and adolescents with acute lymphoblastic leukemia, chemotherapy becomes more effective and the chances of relapse are reduced. To show it, adding a new important element for the treatment of young oncohematological patients, is it studio IDEAL-1, which was made at the Cancer and Blood Disease Institute of the Children’s Hospital of Los Angeles and published in Blood Advances. This is the first study on this disease that shows that with diet and physical activity “it is possible to make chemotherapy more effective in eliminating leukemia cells”, said Etan Orgel, head of the Medical Supportive Care Service at Cancer and Blood Disease Institute of the Children’s Hospital, and lead author of the research.
Overweight children react less well to chemo
In the US, up to 40% of children and adolescents who start treatment for acute lymphoblastic leukemia are overweight or obese. These patients – the researchers explain – have an up to two times higher risk of having persistent minimal residual disease (i.e. leukemia cells still present in the bone marrow after one month of treatment) which is the strongest predictor of poor prognosis and therefore the need for other treatments and medications. To this fact is added another: overweight can be aggravated by the fact that the disease and chemotherapy actually impose a different, complicated and in any case more sedentary life on young patients.
Just 10% fewer calories
Based on these considerations, the researchers placed 40 patients between 10 and 21 years of age with newly diagnosed acute lymphoblastic leukemia in personalized calorie restriction and moderate exercise plans. Result? Those who had reduced calorie intake by at least 10% and followed the physical activity program were 70% less likely to have minimal residual disease than patients who did not participate in the project, one month after the start of the cure. “We have the proof – said Orgel – that we can increase the effectiveness of chemotherapy without adding other drugs with other potential side effects”. We also speak of “a quick, inexpensive and easy to implement intervention, both for those who follow patients and for their families, everywhere”.
Dedicated centers and more trials. This is what young people who have cancer need
by Tiziana Moriconi
New biomarkers?
The researchers also found that by reducing fat mass, insulin resistance decreases and levels of adiponectin, a hormone associated with glucose regulation, increase. These molecules – insulin and adiponectin – could be used as potential biomarkers and allow us to assess whether or not dietary and physical intervention can have a positive impact on other types of cancer.
ALL in children
Acute lymphoblastic leukemia (ALL) is the most frequent pediatric cancer, which affects between 350 and 400 children and teenagers every year in Italy, more often between 2 and 5 years. It originates from lymphocytes, the cells of the immune system and which, in sick people, multiply and accumulate abnormally in the blood, bone marrow and other organs.
The next step
“Changing the diet and exercising made chemotherapy work better. Now we also need to understand how and why, ”said Steven Mittelman, co-author of the study and director of pediatric endocrinology at the University of California, Los Angeles, Mattel Children’s Hospital:” Understanding the biological aspects underlying this effect it will help us improve the intervention. ”For this reason, the start of IDEAL-2, a randomized study that will also be conducted by Orgel and Mittelman, is scheduled for the end of 2021.
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