Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis.

Abstract

(11-58 months), the estimated probability of relapse free survival was 41% (7%) for the whole group. After adjustment in the Cox's multivariate model, malnutrition was the most significant adverse factor affecting duration of complete remission. Age above 8 years and high peripheral white celi count were also significant adverse factors. Among the nutritional indices, the height for age and weight for age z scores were both significant, whether the cut off points of z-2 or z=-1*28 were chosen to define malnutrition. A strong statistical association between the two indices was found; the contribution of height for age z score to the prediction of relapse free survival was more significant. Children with height for age z score <-2 had a relapse risk of 8*2 (95Gb confidence interval 3*1 to 21-9) relative to children with z score > -2. The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries. (Arch Dis Child 1994; 71: 304-3 10)

Zinc supplementation in children and adolescents with acute leukemia

“…It comprises an increased infection rate, which contributes to a poor outcome of the disease. 13,17 A meta-analysis to assess the effects of zinc supplementation on physical growth of children revealed a highly positive response in weight and height increments. 18 This study showed that 28.9% of the patients needed a nutritional intervention at the moment of the first evaluation, bearing in mind the malnourished status and the consumptive characteristic of leukemia.…”

“…[11][12][13][14][15] This large variation is because of several factors such as socioeconomic status and educational and cultural background of children's family, beyond the disease itself. 16 In malnourished children a decreased tolerance to chemotherapy is well known.…”

True

“…The higher incidence of relapse observed in our study may be attributed to the inclusion of patients irrespective of their risk factors, higher male:female ratio (7:1), also malnutrition and concurrent infection which serve as predominant guiding factors in prognostic evaluation of children with ALL in developing countries. 4,5 Interestingly, the lymphoproliferation assay could predict relapse in patients 1, 2, 3, 4, 6, 7, 8, 11, 12 and 14 (10/13) even when leukemic blasts were below the limits of cytomorphological resolution. However, relapse could not be predicted in patients 5, 9 and 13 (3/13) before its morphological detection since they did not come for regular follow-up after attaining remission (MLD = 8 g).…”

“…In fact, although ATRA administration promptly corrects the coagulopathy present in APL, a persistent procoagulant tendency continues to act dur- 3 Some authors referred to an increased expression of adhesion molecules such as VCAM, CD11a, CD11b in polymorphonuclear cells from coronaric sinus of patients with unstable angina. 4 Whether this phenomenon might be primitive (and thus potentially crucial in the destabilization of an atheromasic plaque) or secondary to a disreactive, as well as inflammatory status, is at present unknown. In vitro studies indicate that ATRA is capable of inducing in APL cells the expression of the same adhesion molecules which have been locally found overexpressed in patients with unstable angina.…”

Avaliação da sobrevida de crianças com leucemia linfocítica aguda tratadas com o protocolo Berlim-Frankfurt-Munique

“…Um dos protocolos de maior notoriedade internacional é o desenvolvido pelo grupo alemão Berlim-Frankfurt-Munique (BFM) [7][8][9] . Esse protocolo utiliza a estratificação dos pacientes conforme grupos de risco para ocorrência de recidiva.…”