Effects of pre-existing undernutrition on treatment-related complications and treatment outcomes in children with acute lymphoblastic leukemia: A tertiary care center experience

Background: Our study aimed to assess the influence of undernutrition on treatment tolerance, treatment-related complications, and treatment outcomes in acute lymphoblastic leucomia (ALL) patients during induction and maintenance phase of chemotherapy and subsequent follow-up visits. Materials and Methods: This retrospective, cohort study was conducted between January 2005 and September 2012 in the Departments of Pediatrics and Radiation Oncology in a tertiary care Medical College and Hospital of Eastern India. Using weight-for-age Z scores (WHO), we divided the 159 ALL patients into 4 groups: Group 1 without malnutrition, Group 2 with mild undernutrition, Group 3 with moderate undernutrition, and Group 4 with severe malnutrition. Data regarding blood counts, hematological support, bone marrow remission status and complications during treatment, and follow-up records were analyzed and compared to find out the impact of undernutrition on treatment tolerance and outcomes in different groups. Results: During the intensive phase of chemotherapy treatment, tolerance was assessed by the nadir of absolute neutrophil count and hemoglobin which fell significantly in moderate and severe malnutrition group. Significantly, more packed red blood cell support and platelet transfusions were required by those two groups P < 0.002 and P < 0.001, respectively. The incidence of febrile neutropenia was significantly more in severe malnutrition group (P < 0.001). Ninety-eight (61.63%) patients could not complete chemotherapy within the specified 145-day period of which 23 (76.67%) patients was of severe malnutrition group (P < 0.002). Remission after induction has shown declining trend with more undernutrition. A total of 24 patients relapsed in spite of bone marrow remission which was proportionately more from moderate and severe malnutrition group. During the 5-year follow-up, 20 patients died which was proportionately more in Group 3. Conclusion: Undernutrition adversely affect the final outcome, treatment tolerance, and treatment complications in children with ALL. So, baseline malnutrition should be considered as an important prognostic factor in therapeutic decision of ALL.