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Nutritional Status Changes During Pediatric Acute Lymphoblastic Leukemia Treatment: A Study from a Tertiary Care
Sadia Imran1, Namrita Rai2, Malick Muhammed Sabih Masood1
1Department of Pediatric Hematology & Oncology, Indus Hospital & Health Network, Karachi, Pakistan.
Insights
Malnutrition significantly impacts pediatric Acute Lymphoblastic Leukemia (ALL) patients, increasing infection risk. While weight changes during treatment, malnutrition does not significantly correlate with mortality in these children.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Hematology
Background:
- Acute Lymphoblastic Leukemia (ALL) is a leading pediatric cancer, with survival rates significantly lower in lower-to-middle-income countries (LMICs) compared to high-income countries (HICs).
- Malnutrition is a critical factor influencing treatment outcomes and survival rates in pediatric ALL patients, particularly in resource-limited settings.
Purpose of the Study:
- To investigate the association between nutritional status and morbidity and mortality in pediatric ALL patients undergoing treatment.
- To ascertain changes in nutritional status during and after the intensive phase of ALL treatment.
Main Methods:
- A retrospective study analyzed 332 pediatric ALL patients from May 2022 to April 2023.
- Nutritional status was assessed using WHO weight-for-age and height-for-age for children aged 1-5 years, and BMI-for-age for those over 5.
- Statistical analysis, including the Wilcoxon signed-rank test, was employed to evaluate changes in weight and associations with clinical outcomes.
Main Results:
- Over one-third (38.5%) of the pediatric ALL patients were malnourished, predominantly underweight.
- A significant decrease in patient weight was observed after the intensive treatment phase (P=.0177).
- Malnutrition was significantly associated with increased bacterial infections (P=.01) and multiple hospital admissions (P=.004), but not with mortality (P>.05).
Conclusions:
- Nutritional status undergoes significant changes during intensive ALL treatment.
- Malnutrition in pediatric ALL is linked to higher rates of bacterial infections but not directly to mortality.
- Further prospective research with extended follow-up is recommended to understand the long-term impact of nutritional status on survival in ALL patients.
Background:
Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer with a 5-year survival rate of 90% in High Income Countries (HICs), but in lower-to-middle-income countries (LMICs) survival rates fall below 60%. This is influenced by many factors; one of the major ones being malnutrition.
Objectives:
To ascertain the changes in and association of nutritional status in the treatment of pediatric ALL patients.
Design:
This article investigated the association between nutritional status in patients receiving ALL treatment, and morbidity and mortality. This is a retrospective study for the period of May 2022 to April 2023 including a total of 332 patients.
Methods:
The study used WHO defined weight-for-age and height-for-age for patients from 1 year of age up till the age of 5 years old, and BMI for age for patients over the age of 5 to assess nutritional status. Various disease and treatment variables were analyzed with patients' nutritional statuses.
Results:
From the sample, more than one-third of patients (38.5%) were malnourished with the majority of them being underweight or severely underweight. Wilcoxon signed-rank test for paired values showed a P-value of .0177 (z = 2.373) when used to compare patient weight at initial assessment and weight after intensive phase of treatment, indicating a significant change in weight between both timepoints. Nutritional status was significantly associated with the number of patients with positive bacterial cultures (P = .01) and multiple hospital admissions (P = .004), but was not significantly associated with mortality (P > .05).
Conclusion:
Nutritional status changed significantly after intensive phase of treatment. Malnutrition in ALL patients was significantly associated with bacterial infections, however, it was not significantly correlated to patient mortality. Future prospective studies with a longer study period should be planned to follow patients compromised nutrition to assess long term survival.
Registration:
Not applicable.
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