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Published on: February 9, 2016
Nutritional state alterations in children with acute lymphoblastic leukemia during induction and consolidation of
J M Mejía-Arangure1, A Fajardo-Gutíerrez, R Bernáldez-Ríos
1Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F.
Insights
Children with high-risk acute lymphoblastic leukemia (ALL) experience more nutritional decline, measured by arm muscle area (AMA), during chemotherapy compared to low-risk patients. This nutritional alteration is most pronounced in high-risk patients by the second month of treatment.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Hematology
Background:
- Nutritional status is crucial for children undergoing chemotherapy.
- Acute lymphoblastic leukemia (ALL) treatment involves intensive chemotherapy protocols.
- Risk stratification in ALL impacts treatment intensity and potential side effects.
Purpose of the Study:
- To compare the frequency of nutritional state alterations between high-risk (HR) and low-risk (LR) acute lymphoblastic leukemia (ALL) patients.
- To assess these alterations using arm muscle area (AMA) changes during chemotherapy induction and consolidation phases.
- To identify if HR-ALL patients exhibit a higher incidence of nutritional decline.
Main Methods:
- Concurrent comparative cohort study involving 105 pediatric ALL patients (53 HR, 52 LR).
- Monthly measurements of arm circumference and tricipital skinfold for 3 months.
- Nutritional alteration defined as ≥10% loss of baseline arm muscle area (AMA).
- Statistical analysis included proportion analysis and relative risk (RR) with confidence intervals (CI).
Main Results:
- In the first month, LR-ALL patients showed a higher relative risk (RR=0.77) of nutritional alteration.
- By the second month, HR-ALL patients exhibited a significantly higher RR (7.31) for nutritional state alterations.
- In the third month, HR-ALL patients continued to show a higher RR (1.77) for AMA loss.
Conclusions:
- High-risk ALL patients demonstrate a greater frequency of nutritional state alterations, specifically in arm muscle area, during the second month of chemotherapy.
- The more aggressive chemotherapy regimens used for HR-ALL likely contribute to these observed nutritional deficits.
- Monitoring AMA is a valuable indicator for detecting nutritional changes in pediatric ALL patients undergoing treatment.
Abstract:
The objective of the study was to determine if children with high risk acute lymphoblastic leukemia (ALL) exhibit higher frequency of alterations in nutritional state during the phases of induction and consolidation of chemotherapy than children with low risk ALL, based on the arm muscle area. The design was concurrent comparative cohorts. It was performed at pediatric hematology service of the Hospital General del Centro Médico Nacional "La Raza" and hematology service of the Hospital de Pediatría del Centro Médico Nacional "Siglo XXI". One hundred-five patients were incorporated into the study: 53 with high risk (HR) ALL and 52 with low risk (LR) ALL. Basal measurements of arm circumference and tricipital skinfold were surveyed monthly (for 3 months) by standardized personnel. Altered nutritional state during follow-up was defined as the loss of 10% or more of the arm muscular area (AMA) measured at diagnosis. Statistics of proportion analysis with a significance level of 0.05 and relative risk (RR) with confidence intervals (CI) were calculated. In the first month the RR was 0.77 (CI 0.31-1.87); the LR group was the most affected. In the second month the RR was 7.31 (CI 1.41-38.03); the most affected group was the HR. In the third month the RR was 1.77 (CI 0.60-4.92); the HR group was the most affected. High-risk patients show a higher frequency of nutritional state alterations reflected in AMA during the second month after diagnosis. This may be caused by the more aggressive chemotherapy received by these patients.
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