Evidence map›Paper›PMID 42655909›Full record

ArticleCancer medicine2026

Diagnostic BMI and Induction Therapy Weight Change Associated With Hepatotoxicity in Pediatric Patients With Acute Lymphoblastic Leukemia.

Emily J Mason, John P Woodhouse, Jeremy M Schraw, Joanna S Yi, Karen R Rabin, M Monica Gramatges, Mark C Zobeck, Baojiang Chen, Melissa B Harrell, Olga A Taylor and 6 more

Abstract read
In one paragraph

Article in Cancer medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Emily J MasonDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.ORCID https://orcid.org/0000-0001-8120-2138
John P WoodhouseDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Jeremy M SchrawDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.ORCID https://orcid.org/0000-0002-6674-9562
Joanna S YiDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Karen R RabinDepartment of Pediatrics, University of California San Francisco, San Francisco, California, USA.ORCID https://orcid.org/0000-0002-4081-8195
M Monica GramatgesDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.ORCID https://orcid.org/0000-0002-0947-104X
Mark C ZobeckDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.ORCID https://orcid.org/0000-0003-0997-906X
Baojiang ChenSchool of Public Health, University of Texas Health Science Center at Houston, Austin, Texas, USA.ORCID https://orcid.org/0000-0002-9683-9390
Melissa B HarrellSchool of Public Health, University of Texas Health Science Center at Houston, Austin, Texas, USA.
Olga A TaylorDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Michael E ScheurerDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.ORCID https://orcid.org/0000-0002-8379-6088
Philip J LupoDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.ORCID https://orcid.org/0000-0003-0978-5863
Van HuynhHyundai Cancer Institute, Children's Hospital of Orange County (CHOC), Orange, California, USA.ORCID https://orcid.org/0000-0002-2781-5627
Steven D MittelmanDepartment of Pediatric Endocrinology, University of California Los Angeles, Los Angeles, California, USA.ORCID https://orcid.org/0000-0003-2867-1298
Etan OrgelCancer and Blood Disease Institute, Children's Hospital of Los Angeles, Los Angeles, California, USA.ORCID https://orcid.org/0000-0002-1487-6818
Austin BrownDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.ORCID https://orcid.org/0000-0001-5802-5073

Funding

Reducing Disparities in Acute Leukemia (REDIAL) Consortium U54CA302464 · NCI · BAYLOR COLLEGE OF MEDICINE · PI Karen R Rabin · 2025 to 2026
$7.2M
Survivorship and Access to care for Latinos to Understand and Address health outcome Differences (SALUD)UH3CA260607 · NCI · BAYLOR COLLEGE OF MEDICINE · PI Maria Monica Gramatges, LISA SCHUM KAHALLEY · 2023 to 2026
$6.3M
Improving Outcome Disparities for Latino Children and Adolescents with Acute Lymphoblastic LeukemiaP20CA262733 · NCI · BAYLOR COLLEGE OF MEDICINE · PI GRAMATGES, MARIA MONICA · 2021 to 2023
$3.2M
Cancer Prevention and Research Institute of Texas RP160771Cancer Prevention and Research Institute of Texas RP210064Cancer Prevention and Research Institute of Texas RP230026NCI NIH HHS P20 CA262733NCI NIH HHS P20CA262733NCI NIH HHS U54 CA302464NCI NIH HHS U54CA302464NCI NIH HHS UH3 CA260607NCI NIH HHS UH3CA260607St. Baldrick's Foundation 522277
6 · The paper itself

Abstract

backgroundHepatotoxicity is a common treatment-related complication in pediatric acute lymphoblastic leukemia (ALL). Excess adiposity at diagnosis has been identified as a risk factor, but the impact of weight change during therapy has not been examined.

methodsWe included patients aged 2-20 years newly diagnosed with ALL between 2005 and 2021. Hepatotoxicity was defined as: (1) transaminitis (ALT/AST > 10× the upper limit of normal), or (2) conjugated hyperbilirubinemia (cbili; > 3.0 mg/dL during induction/> 2.0 mg/dL post-induction). Youden's J was used to identify optimal BMI z-score thresholds. Cox proportional hazards regression was used to assess associations between hepatotoxicity during treatment and diagnostic BMI and post-induction hepatotoxicity and weight change during induction. Associations were adjusted for age, race, ethnicity, and treatment risk stratification. Patients were censored at qualifying event or 1200 days post-diagnosis.

resultsAmong 1070 patients (median age 6 years), 45.8% developed transaminitis and 7.6% cbili. Optimal BMI z-score cut points were -1.5 and 1.5 for transaminitis and 1.5 for cbili. A BMI z-score ≤ -1.5 was associated with reduced transaminitis (HR = 0.58, 95% CI: 0.39-0.86; p = 0.006), while a z-score ≥ 1.5 was associated with increased transaminitis (HR = 1.32, 95% CI: 1.06-1.65; p = 0.01). A BMI z-score ≥ 1.5 was also associated with increased cbili (HR = 1.97, 95% CI: 1.23-3.18; p = 0.01). Weight change was not associated with transaminitis, but weight loss during induction was associated with an increase in hazard of post-induction cbili (HR = 1.08, 95% CI: 1.04-1.11; p < 0.0001).

conclusionDiagnostic BMI z-score and weight loss during induction were associated with increased hepatotoxicity risk, highlighting potential targets for improved risk stratification and hepatoprotective interventions.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsBody Mass IndexChemical and Drug Induced Liver InjuryInduction ChemotherapyPrecursor Cell Lymphoblastic Leukemia-LymphomaWeight GainAdolescentChildChild, PreschoolFemaleHumansMaleRetrospective StudiesRisk FactorsYoung Adult

Identifiers

PMID42655909
PMCPMC13519099

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.