A single-centre retrospective study investigating changes in nutritional status and use of dietetic interventions in...

Chimeric antigen receptor T-cell therapy (CAR-T) is a novel treatment for children with relapsed or refractory acute lymphoblastic leukaemia. Preferential outcomes have been shown when children maintain their nutritional status during cancer treatment. Few studies have investigated the impact of CAR-T on the nutritional status of children. This study aimed to examine the nutritional status and use of dietetic interventions in children having CAR-T.

Electronic records of all children who had CAR-T between June 2015-June 2024 at Great Ormond Street Hospital in London were retrospectively reviewed. Nutritional outcomes were examined during the child's admission for CAR-T, including weight change and dietetic interventions used including oral nutritional supplements, enteral tube feeding and parenteral nutrition. Impact of different interventions on children's weight change and length of stay were analysed.

CAR-T was provided to 132 children, 65 % male, mean age eight years. Weight change from CAR T-cell infusion to discharge was a mean loss of -1.8 %. Sixty two percent required a dietetic intervention and of these 45 % received oral nutritional supplements, 56 % enteral tube feeding (of these 87 % had a nasogastric tube, 13 % a gastrostomy), 34 % parenteral nutrition. The latter was initiated primarily for intolerance to tube feeding and provided for a mean 23 days. Children who received any dietetic intervention gained more weight than those who received none (+0.7 % v -1.6 %, p = 0.020), as did those who initiated oral nutritional supplements proactively (before day three post-CAR T-cell infusion) versus reactively (on or after day three) (+0.4 % v -3.3 %, p = 0.030), and those who started tube feeding proactively versus reactively (+2.4 % v -3.6 %, p = 0.027). Length of stay was shorter for children who did not receive any dietetic intervention than those who did (19 days v 30, p < 0.001), and those who did not receive tube feeding versus those who did (22 v 32 days, p = 0.001).

Although children experienced a modest weight loss the majority required a dietetic intervention to support this, most commonly oral nutritional supplements and tube feeding. Proactive preparation of families for tube feeding is essential to facilitate acceptance. Children who did not receive a dietetic intervention may have benefitted from dietetic input. With growing evidence of changes in nutritional status and impact on outcomes, dietetic input is key to develop nutritional support algorithms that guide the use of screening, assessment and interventions in children having CAR-T.