Malnutrition, maintenance dose intensity and event-free survival in children with acute lymphoblastic leukemia

Abstract

The role of malnutrition in event-free survival (relapse or death) in children with acute lymphoblastic leukemia (ALL), admitted at the Rio Blanco Regional Hospital, is assessed. The files of children under 12 years of age with ALL, diagnosed and treated from 1990 to 1997 were analyzed. According to the score z (≤1.28) of the weight/age, height/age, and weight/height anthropometric indicators, children were classified into two groups: nourished and malnourished children. Event-free survival curves were made and the impact that other risk factors had on prognosis was analyzed. The association of age, white blood cells and nutritional status, in the presence of an unfavorable event was estimated, using a multiple regression model. Twenty-three patients were studied, of which 12 suffered malnutrition. The mortality rate among the malnourished children was of 50% versus 9.1%, among the nourished children in the survival curve, and in the log rank test the weight versus age was of significant influence (p<0.04). The two most relevant risk factors for the presence of events were malnutrition and L2 type leukemia. In a multiple regression model, malnutrition was the only factor associated with the presence of events. Malnutrition was a risk factor for the presence of unfavorable events, being even more important than age and white blood cell count. Prospective studies that analyze the relationship of malnutrition and ALL, as well as the pharmacokynetics of antineoplastic agents in malnourished patients, are needed.