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Published on: November 21, 2018
Nutritional Status of Pediatric Patients With Acute Lymphoblastic Leukemia Under Chemotherapy: A Pilot Longitudinal
Ibrahim Kandemir1, Sema Anak2, Serap Karaman3
1Department of Pediatrics, Faculty of Medicine, Biruni University.
Insights
Children with acute lymphoblastic leukemia (ALL) face malnutrition risks during chemotherapy, especially younger patients. Nutritional status requires close monitoring throughout treatment to manage weight changes and potential obesity.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Hematology
Background:
- Nutritional status is critical for children undergoing chemotherapy for acute lymphoblastic leukemia (ALL).
- Malnutrition poses a significant challenge alongside cancer treatment in pediatric patients.
Purpose of the Study:
- To investigate the nutritional status of children with ALL during chemotherapy.
- To assess anthropometric data and key nutrient levels at different treatment phases.
Main Methods:
- A longitudinal study of 17 children (1-16 years) with ALL across five Istanbul centers.
- Assessed anthropometric measurements, serum prealbumin, vitamin B12, and folate levels at diagnosis, post-induction, and pre-maintenance chemotherapy.
Main Results:
- Significant weight loss and decreased serum prealbumin, weight-for-height, and weight-for-age ratios were observed post-induction chemotherapy.
- Children under 60 months showed lower prealbumin levels and were below reference values.
- Weight and weight-for-age significantly increased before maintenance, indicating a potential obesity risk; serum folate levels rose, while vitamin B12 remained stable.
Conclusions:
- Malnutrition is a risk at the end of ALL induction chemotherapy, necessitating close nutritional monitoring, particularly in children under five.
- Weight gain and potential obesity risk emerge before the maintenance phase.
- Further research is required to comprehensively evaluate nutritional status throughout childhood ALL chemotherapy.
Background:
The study investigates the nutritional status in children with acute lymphoblastic leukemia (ALL) during chemotherapy treatment because nourishment is substantial, as much as chemotherapy in children with malignant diseases.
Material And Method:
We enrolled 17 children with ALL (between 1 to 16 year-old, mean age 6.03 ± 4.04 y) from 5 different centers in Istanbul between September 2013 and May 2014. Anthropometric data, prealbumin, B12, and folate levels were assessed, at diagnosis, after the induction phase of chemotherapy, and before maintenance phases of chemotherapy in a longitudinal and prospective study.
Results:
Patients remarkably lost weight at the end of the induction phase ( P =0.064) and regained this loss before maintenance chemotherapy ( P =0.001). At the end of induction chemotherapy serum prealbumin level ( P =0.002), weight for height ratios ( P =0.016), weight for age ratios ( P =0.019) significantly decreased. From the end of the induction phase to the beginning of maintenance chemotherapy, weight ( P =0.001) and weight for age ( P =0.017) significantly, and weight for height were remarkably elevated ( P =0.076). At the end of the induction phase, serum prealbumin levels were significantly lower ( P =0.048) and below laboratory reference values ( P =0.009) in children younger than 60 months compared with those older. Serum folate levels increased from the end of the induction phase to the beginning of the maintenance phase ( P =0.025). Serum vitamin B12 levels did not alter significantly.
Conclusion:
There is malnutrition risk at the end of the induction phase of the ALL-BFM chemotherapy regimen; therefore, clinicians should follow up on nutrition closely, especially in under 5-year-old patients. However, before the beginning of the maintenance phase, children start to gain weight, and obesity risk occurs. Thus , further studies are needed to evaluate nutritional status during childhood ALL chemotherapy.
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