The Need for Evidence Based Nutritional Guidelines for Pediatric Acute Lymphoblastic Leukemia Patients: Acute and Long-Term Following Treatment

Abstract

High survival rates for pediatric leukemia are very promising. With regard to treatment, children tend to be able to withstand a more aggressive treatment protocol than adults. The differences in both treatment modalities and outcomes between children and adults make extrapolation of adult studies to children inappropriate. The higher success is associated with a significant number of children experiencing nutrition-related adverse effects both in the short and long term after treatment. Specific treatment protocols have been shown to deplete nutrient levels, in particular antioxidants. The optimal nutrition prescription during, after and long-term following cancer treatment is unknown. This review article will provide an overview of the known physiologic processes of pediatric leukemia and how they contribute to the complexity of performing nutritional assessment in this population. It will also discuss known nutrition-related consequences, both short and long term in pediatric leukemia patients. Since specific antioxidants have been shown to be depleted as a consequence of therapy, the role of oxidative stress in the pediatric leukemia population will also be explored. More pediatric studies are needed to develop evidence based therapeutic interventions for nutritional complications of leukemia and its treatment.

Changes in cell death of peripheral blood lymphocytes isolated from children with acute lymphoblastic leukemia upon stimulation with 7 Hz, 30 mT pulsed electromagnetic field

“…Several congenital genetic abnormalities have been linked to predisposition to childhood ALL, lending support to a genetic basis for ALL susceptibility children with Down syndrome (constitutive chromosome 21 trisomy) are at a significantly elevated risk of developing acute leukemia, particularly AML and ALL with somatic cytokine receptor-like factor 2 (CRLF2) lesions [2,3]. T-cell acute lymphoblastic leukemia (T-ALL) represents about 15% of pediatric ALL cases and is generally associated with unfavorable clinical features and aggressive biologic behavior such as higher risk for primary resistant disease, early relapse and isolated central nervous system relapse compared with B-progenitor ALL patients [4][5][6][7]. The prognosis of T-ALL in children and adolescents has improved in recent years as a result of more intensive chemotherapy approaches, but it remains worse compared to B-lineage acute leukemia, especially in the presence of a poor initial response to therapy [8][9][10].…”

Nutritional Considerations in Childhood Acute Lymphoblastic Leukemia

“…Cancer can almost start anywhere in the human body. These unregulated cells may spread to other organs and tissues, thus turning into cancer or become situational tumor (Owens, 2013). A blood stem cell goes through several steps to become a red blood cell, platelet, or white blood cell Leukemia is one of the many forms that cancer might take.…”

“…It is further sub-divided to lymphoid (lymphocytic or lymphoblastic) or myeloid cells. Chronic lymphocytic leukemia, chronic myeloid leukemia, acute lymphocytic leukemia (ALL), acute myeloid leukemia are common types of leukemia of which ALL is the most common type of cancer in children (Owens, 2013).…”

“…Meanwhile the overall incidence of ALL has been increasing slowly in the past decades. For instance, it is nearly about 30 to 40 case in every 1 million in pediatrics under the age of 20 years old in the United States (Owens, 2013). Each year relatively 3100 US people who are under the age of 20 are diagnosed with ALL.…”

The Effectiveness of Enteral Nutrition Support in the Growth of Children Patients with Cancer

“…The malnutrition levels are as high as 17% in children with newly diagnosed localized tumors and 37% in subjects with metastatic disease. Modern pediatric cancer treatment affects normal as well as malignant tissues and is thus capable of causing specific nutritional problems [2]. Nutrition assessment represents the first step in clinical nutrition management in pediatric oncology patients [3].…”