Outcomes of Weight Loss during Induction Therapy for Childhood ALL

Pediatric patients with acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LLy) often experience significant weight gain during remission induction therapy. However, some experience significant weight loss instead. This population is not widely recognized. This study aims to determine whether significant weight loss during induction therapy decreased likelihood of reaching end of therapy (EOT) or increased risk of death or relapse. This was a retrospective study of 187 patients, aged 2-20 years, diagnosed with ALL and LLy at Cook Children's Medical Center from 1/1/11 to 3/31/17. Percent weight change from diagnosis to end of induction was grouped: loss (≥5% loss), gain (≥5% gain), and steady (< 5% loss/gain). To examine outcomes of weight loss, logistic regression was used for reaching EOT and Cox regression for death and relapse. Weight-change categories were 17% loss, 39% steady, and 45% gain. Eighteen (10%) patients did not reach EOT; 10 (5%) patients died; and 22 (12%) patients relapsed. Compared to the steady category, patients who lost weight were significantly less likely to reach EOT (OR=0.31, 95% CI=0.16-0.63, p< 0.01). Though nonsignificant, the hazard ratios demonstrated increased risk of death (HR=3.67, 95% CI=0.81-16.52, p=0.09) and relapse (HR=1.83, 95% CI=0.60-5.60, p=0.29). Patients in the steady and gain groups did not significantly differ in any outcomes (p>0.05). Patients who experience malnutrition during induction therapy may be at greater risk for not completing therapy. Those in the loss group had higher mortality rates (13%) than those in the steady or gain (4%) groups.