Impact of Nutritional Status on Induction Mortality in Paediatric Acute Lymphoblastic Leukaemia

Abstract

OBJECTIVE: To study the impact of nutritional status on induction mortality among pediatric patients suffering from acute lymphoblastic leukemia (ALL).
 METHODS: This descriptive analytical study was conducted on pediatric ALL patients who completed induction chemotherapy in Pediatric Oncology Department Combined Military Hospital, Rawalpindi, Pakistan from 1st January 2012 to 30th June 2021. All patients of ALL diagnosed on basis of National Comprehensive Cancer Network Clinical Practice Guidelines, aged 1-18 years were included. Patients who left before completion of induction chemotherapy or refused to participate were excluded. Cases were divided into three groups based on nutritional status. Induction chemotherapy was given as per UKALL 2011 protocol.
 RESULTS: Out of 926 patients diagnosed with ALL, 586 (63.3%) were males and 340 (46.7%) were females. Mean age of patients was a 5.83±3.627 years. Majority of the patients (n=679, 73.3%) were well-nourished; and 161 (17.4%) and 86 (9.3%) were moderately and severely malnourished, respectively. About 49.8% (n=461) patients received standard risk chemotherapy protocol with three-drug induction and 50.2% (n=465) received four-drug induction chemotherapy. Infection was the most common complication in 742 (80.1%) patients. Overall induction mortality was 12.9% (n=119/926) in all patients including 9.54% (n=44/461) in standard-risk and 16.12% (n=75/465) in high-risk patients (p=0.003). Induction mortality was significantly high in malnourished-group (17.8%) and 12.2% in normally-nourished children (p=0.008).
 CONCLUSION: Nutritional status and risk group at time of diagnosis emerged as predictors of induction mortality among ALL patients. Considerable number of patients died during induction phase of treatment. Malnourished children have a high mortality rate.