Nutritional Assessments in Pediatric Patients with High Risk Neuroblastoma

Abstract

Background There have been few improvements in nutritional supportive care for high-risk neuroblastoma (NBL) patients in the past decade. Malnutrition is associated with treatment delays, increased risk of infection, and decreased survival. We reviewed pediatric patients with high risk Neuroblastoma undergoing autologous stem cell transplant (ASCT) at the Medical University of South Carolina (MUSC) from January 2011 through June 2018 to estimate their nutritional status at diagnosis and ASCT. Methods We reviewed the medical records pediatric NBL patients who underwent ASCT at MUSC from January 2011 through June 2018. Patients were treated on/per clinical trials NMTRC012, ANBL0532, or ANBL12P1. All received 5-6 cycles of chemotherapy and surgery prior to ASCT. We collected height and weight on treatment day 1 and at the time of BMT admission. We calculated a BMI-age adjusted-Z score. We used the prolate elliptical volume estimate based on diagnostic CT scan measurements (L x W x D x Π)/6 to estimate tumor weight at diagnosis. Results Twenty-four patients were analyzed and tumor weight averaged of 3.04 % of the body weight at diagnosis for our patients. Seven patients (29%) had an initial Z score of Discussion Pediatric NBL patients have several features that can impact their nutrition including abdominal masses causing decreased appetite, and precluding early G-tube placement. Treatments are emetogenic, intensively timed and lengthy. Our data demonstrated that G-tube placement and the start of supplemental nutrition occurred late in the treatment. Our data suggest that earlier nutritional intervention may be required, and that nutritional measures that are non-weight based may better characterize nutritional status and would not be impacted by tumor burden. Conclusions • Pediatric NBL patients are high risk for malnutrition • Weight based nutritional assessments may overestimate status • G-tubes placement time provides a target for earlier nutritional interventions • Data from later time-points is needed to determine if nutrition via G-tube is beneficial Future directions • A trial with multifaceted nutritional assessments and interventions for patients with high risk neuroblastoma is under development.