Nutrition and acute leukemia in adults: relation to remission rate and survival

Because malnutrition may augment myelotoxicity of antileukemic drugs, we tested whether changes of the nutritional state during first remission induction chemotherapy were related to remission rates and times. Thirty-seven adult patients, average 49 years (range 15-74), with acute leukemia were studied during first remission induction chemotherapy. Weight changes were classified into one of four separate groups, ranging from minimal weight changes to > 10 kg loss. The patients were followed until death or complete remission. During the induction period, patients lost (in mean) 5.1 kg body weight, had severe neutropenia (i.e., less than 0.1 x 10(9)/1) and fever for 25-26% of this time. Patients exhibiting moderate weight reduction (i.e., 2-5.9 and 6-9.9 kg; n = 22) were neutropenic and febrile for 23% of the induction period; they displayed the highest remission rates, 90 and 92%, respectively. In contrast, patients in the minimal or maximal weight change groups (i.e. a loss of < 2 kg; n = 8, or > 10 kg; n = 7), showing shortest or longest duration of neutropenia (20% and 36%, respectively) and fever (25% and 42%), had the lowest remission rates, 50 and 63%, respectively. By logistic regression analyses, change of weight and time with fever were associated with remission rates. However, none of these variables were related to remission times. We may conclude that in adult acute leukemia patients a moderate weight loss (together with intermediate duration of neutropenia and fever) was associated with the highest remission rates.