Prevalence and Risk Factors for Malnutrition during Pediatric Acute Lymphoblastic Leukemia Induction Therapy

Purpose It is well documented that pediatric patients with acute lymphoblastic leukemia (ALL) often experience significant weight gain during induction therapy and later struggle with obesity. However, some patients experience unintended weight loss during induction therapy; since this issue is not well reported, it often goes unnoticed or undertreated. Although malnutrition is reported to be associated with decreased survival, increased risk of infection and loss of lean body mass, there remains a scarcity of in depth analysis of prevalence and risk factors that contribute to this problem. Our study attempts to address this critical yet unmet need. Our aim was to identify the clinical risk factors and outcomes associated with weight loss during induction therapy for pediatric ALL. Design/Method This was a retrospective chart review of patients between 2 and 20 years of age diagnosed with ALL at Cook Children’s Medical Center from 4/1/14 to 3/31/17. For each patient, we collected height, weight, age, body mass index (BMI) z-scores at diagnosis and end of induction therapy, risk stratification, and whether consolidation was delayed. Patients with a BMI z-score [greater than] 85th percentile at diagnosis were categorized as being overweight or obese. Using logistic regression analyses, we examined which variables predicted whether the patient had an increase or decrease in BMI z-score throughout induction. A critical alpha level of 0.05 indicated statistical significance. Results Ninety-six patients met our inclusion criteria. Of these, 40% experienced a decrease in BMI during induction therapy. Compared to patients whose BMI increased during induction, patients with a decrease in BMI were more likely to be overweight or obese at diagnosis (55% vs. 22%; p Conclusion This research highlights a risk not previously identified in the literature that may impact outcomes. Patients treated on high- or very-high-risk protocols, who are overweight or obese at diagnosis, and who are ≥10 years old at diagnosis should be monitored closely for weight loss during induction therapy. Patients who experience weight loss should receive prompt intervention. It is our hope that this information can be used for future prospective studies and help develop evidence-based guidelines.