Purpose: The study aimed to determine the body composition of Japanese adult survivors with childhood cancer. Methods: Between August 2018 and September 2019, we recruited adults aged ≥18 years who had childhood leukemia/lymphoma. Blood sampling, body composition measurement by bioelectrical impedance analysis (BIA), grip strength test, nutrition consultation, and screen viewing time survey were conducted. Results: We analyzed the data of 81 survivors with a median age of 25 years. The disease profile comprised 51 cases of acute lymphocytic leukemia, 20 acute myelocytic leukemias, and 10 lymphomas; 34 patients had undergone hematopoietic stem cell transplantation (HSCT). The average body mass index (BMI) was 21 kg/m2. Of the patients, 10 (12%) were obese and 18 (22%) were lean. Three patients had metabolic syndromes (MS) and 9 had sarcopenia. There was no significant difference in the frequency of obesity, sarcopenia, and MS in each disease; however, sarcopenia was significantly higher in the transplant group. Further, 30% of obese patients had MS, and 33% of lean patients had sarcopenia. Discussion: Leanness and sarcopenia are common in HSCT survivors, and the possible involvement of transplant-related complications is accordingly suspected. The effects of lifestyle cannot be ruled out, and more cases must be analyzed to examine risk factors. Conclusion: Some young adult survivors with childhood leukemia/lymphoma may have metabolic syndrome (MS) or sarcopenia. Assessments of body composition by BIA for childhood cancer survivors could benefit to detect MS or sarcopenia in their young adulthood.

Background: The prognosis of children with acute myeloid leukemia (AML) has improved with the efficacy of hematopoietic cell transplantation as a second-line therapy and improvements in supportive care following anthracycline- and cytarabine-based chemotherapy; however, the outcomes of children with relapsed AML still remain unsatisfactory. Procedure: In order to identify prognostic factors and improve their prognosis, we analyzed 111 patients who relapsed after treatment with the Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) AML-05 protocol and who were registered in the retrospective JPLSG AML-05R study. Results: The 5-year overall survival rate was 36.1%. The major determinant of survival was duration from the diagnosis to relapse. The mean duration in the non-surviving group (10.1 ± 4.1 months) was shorter than that in the surviving group (16.3 ± 8.3 months) (p<0.01). Moreover, achieving a second complete remission (CR2) prior to hematopoietic cell transplantation was associated with a good prognosis (p<0.01). Etoposide, cytarabine and mitoxantrone (ECM)- or fludarabine, cytarabine and granulocyte colony-stimulating factor (FLAG)-based regimens were therefore recommended for reinduction therapy (p<0.01). A genetic analysis also revealed the prognostic significance of FMS-like tyrosine kinase 3 (FLT3)-internal tandem duplication as a poor prognostic marker (p=0.04) and core binding factor-AML, t(8;21) and inv(16), as good prognostic markers (p<0.01). Conclusions: Achieving a CR2 prior to HCT is important in order to improve the prognosis of relapsed pediatric AML. Recent molecular targeted therapies, such as FLT3 inhibitors, may contribute to overcome their prognoses. Larger prospective investigations are necessary to establish individualized treatment strategies for patients with relapsed childhood AML.