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Nutritional status at initial presentation in childhood acute lymphoblastic leukemia and its effect on induction of
1Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh.
Insights
Undernutrition is common in childhood acute lymphoblastic leukemia (ALL), increasing infection risk and prolonging treatment. Nutritional support is vital for improving remission induction outcomes in these young patients.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Hematology
Background:
- Childhood acute lymphoblastic leukemia (ALL) is a significant health concern.
- Nutritional status at diagnosis can impact treatment outcomes.
- Limited data exists on the nutritional profile of ALL patients in Bangladesh.
Purpose of the Study:
- To evaluate the nutritional status of children with ALL at initial presentation.
- To determine the effect of nutritional status on remission induction.
- To identify nutritional challenges in pediatric ALL management.
Main Methods:
- Prospective study of 66 children diagnosed with ALL (age 1-15 years).
- Stratification into undernourished and well-nourished groups based on weight-for-age.
- Monitoring of remission induction via clinical, hematological, and bone marrow examinations.
- Assessment of infection rates and duration of induction/hospital stay.
Main Results:
- Over 53% of children with ALL presented as undernourished.
- Undernourished children had lower weight and hemoglobin levels.
- Undernourished patients experienced significantly higher rates of infection (2-3 times more common).
- Longer induction duration and hospital stays were observed in undernourished children (p<0.001).
Conclusions:
- Undernutrition is prevalent at diagnosis in childhood ALL.
- Undernourished children face increased infection risks, complicating treatment.
- Optimizing nutritional support is crucial for successful remission induction and improved outcomes in pediatric ALL.
Abstract:
This prospective study was aimed to evaluate the nutritional status at initial presentation in childhood acute lymphoblastic leukemia (ALL) and to ascertain the effects of nutrition on induction of remission. The study was carried out in the Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of one year starting from July 2006 to June 2007 on 66 diagnosed case of ALL, age ranged from 01 to 15 year irrespective of sex. The study subjects were stratified into undernourished (35) and well-nourished (31) based on weight for age. Then, protocol based induction of remission was started. Completion of induction was monitored through physical, haematological and morphological examination of bone marrow aspirate. Infection was ruled out clinically and culture sensitivity. Demographic, anthropometric, haematological, clinical and outcome variables were considered in both groups. At initial presentation, 53.03% were undernourished and 46.97% were well-nourished. Male preponderance was found in both groups. Under-nourished children of ALL had significantly decreased weight (p<0.03) and low haemoglobin concentration (p<0.04) at initial presentation. The undernourished children at initial presentation and during induction had about 2 to 3 times more common of culture and clinically proved infection. Undernourished children of ALL required significantly longer duration of induction (p<0.001) and prolonged period of hospital stay (p<0.001). So, it is concluded that under-nutrition is very usual at initial presentation in childhood ALL, are more prone to suffer from infection and thus prolong the duration of induction, hospital stay, even can lead to death. Optimum nutritional support can play a vital role in the outcome of induction of remission in childhood ALL.
