Visceral Fat and Body Fat Linked to Methotrexate Toxicity in Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma

A recent study published in Pediatric Blood & Cancer has shed light on the relationship between visceral fat and body fat mass as risk factors for methotrexate toxicity in pediatric acute lymphoblastic leukemia and lymphoblastic lymphoma. Researchers at the Nacional Institute of Pediatrics in Mexico City, Mexico, analyzed the body composition of 150 patients aged 6-18 years with ALL and lymphoblastic lymphoma who received high-dose methotrexate without prior toxicity. The study found that patients with a high visceral fat area (VFA) and body fat mass were at a significantly higher risk of late methotrexate toxicity, including severe cases.

Key Takeaways:

• The study included 150 patients aged 6-18 years with ALL and lymphoblastic lymphoma who received high-dose methotrexate without prior toxicity.
• Patients with a VFA ≥ 47 cm had a significantly higher risk of late toxicity (RR 2.8, p = 0.01), and those with high body fat mass (≥ 47 cm) had a significantly higher risk of late and severe late toxicity (RR 2.0, p = 0.01 and RR 2.3, p = 0.03, respectively).
• No significant associations were found with low phase angle, low skeletal muscle index, or overweight body mass index.
• The study concluded that a VFA ≥ 47 cm and a high percentage of body fat mass were associated with an increased risk of late methotrexate toxicity and severe late toxicity.

Statistics:

• 30.2% of methotrexate toxicity events occurred early, and the figure increased to 58.7% for late toxicity.
• Patients with a VFA ≥ 47 cm had a significantly higher risk of late toxicity (RR 2.8, p = 0.01).
• Those with high body fat mass (≥ 47 cm) had a significantly higher risk of late and severe late toxicity (RR 2.0, p = 0.01 and RR 2.3, p = 0.03, respectively).

Sources:

• Visceral Fat and Body Fat as Risk Factors for Methotrexate Toxicity in Pediatric Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma. Pediatric Blood & Cancer, 2025.
• Nacional Institute of Pediatrics, Mexico City, Mexico
• Ximena Monserrat Torreblanca-Garcia, Servicio De Oncologia Medica, National Institute of Pediatrics, Mexico City, Mexico
• Alda Daniela Garcia-Guzman, Sandra Nayeli Becerra-Morales, Torres-Lastra Andrea Del Carmen, Daniela Assenet Moctezuma-Sandoval, Karla Maldonado-Silva, Isabel Medina-Vera, and Liliana Velasco-Hidalgo.
• Pediatric Blood & Cancer can be contacted at: Wiley, 111 River St, Hoboken 07030-5774, NJ, USA