Impact of Nutrition on Treatment Outcome in Acute Lymphoblastic Leukaemia of Childhood in Developing Country
Authors: Mukhopadhyay Soma , Gangopadhyay Sudeshna , Gupta Pinaki , Basak Jayasri , Mukhopadhyay Ashis 
Published: October 2019

Abstract
Abstract 4744
Malnutrition is a major problem in children with cancer. All conventional modalities of anti cancer therapy interfere with normal nutrition. In this study we retrospectively analyzed 331 children of Acute Lymphoblastic Leukaemia (ALL) being intensively treated by National cancer Institute protocol (MCP 841) during period from August, 2000 to December, 2010 in a tertiary cancer institute of the country. Our aim was to determine the nutritional status of children with ALL at diagnosis and to study the influence of nutrition on complete remission, disease free survival (DFS) and toxicity of chemotherapy. The variables studied were height for age, weight for age and serum albumin levels. The height for age and the weight for age were taken as normal if they were between 3rd and 97th percentile curve of the growth chart as recommended by the Indian Council of Medical Research (ICMR). The albumin level was considered normal if the value was equal to or more than 3 gm%. It was seen that 16.9% children were low weight for age and 10.3% were of low height for age at diagnosis. Low weight for age (p value <0.01) and low albumin (p-value <0.005) were significant in DFS.
We conclude that malnutrition is having much impact on prognosis of ALL in developing countries like ours. The major nutrition indicators are height for age, weight for age and serum albumin. The patients with malnutrition have less DFS duration, more chances of relapse and more toxicity during therapy as compared to well nourished children.Table 1:Nutritional status of 331 childrenVariablesNormalLowWeight for age275 (83.08%)56 (16.91%)Height for Age297 (89.73%)34 (10.3%)Total Protein274 (82.78%)57 (17.22%)Serum Albumin301 (90.94%)30 (9.06%)Table 2:Effect of Nutritional variables on remission of ALLVariableTotalRemissionNon ResponderInduction DeathTotal failure of Inductionp-valueNormal Weight for age275260 (94.54%)4 (1.45%)11 (4%)15 (5.45%)Low Weight for Age5651 (91.1%)05 (8.9%)5 (8.9%)0.236Normal Height for Age297283 (95.23%)4 (1.35%)10 (3.37%)14 (4.7%)Low Height for Age3428 (82.35%)1 (2.94%)5 (14.7%)6 (17.6%)Normal Albumin301287 (95.35%)2 (0.66%)12 (4%)14 (4.6%)Low Albumin3024 (80%)2 (6.7%)4 (13.3%)6 (20%)Table 3:Effect of Nutritional variables on Disease Free SurvivalVariableTotalDFS (%)Relapse Death (%)Death due to Other Causes (%)Total Deathp-valueNormal Weight for age275198 (72%)59 (21.45%)18 (6.54%)77 (28%)Low Weight for Age5619 (33.9%)25 (44.6%)12 (21.4%)37 (66%).001Normal Height for Age297213 (71.7%)68 (22.9%)16 (5.4%)84 (28.3%)Low Height for Age344 (11.8%)20 (58.8%)10 (29.4%)30 (88.2%)0.0001Normal Albumin301212 (70.4%)62 (20.6%)27 (8.97%)89 (29.6%)Low Albumin305 (16.7%)13 (43.33%)12 (40%)25 (83.3%)0.0001Table 4:Effect of Nutritional variables on Toxicity ProfileVariableMyeloLiverGINeuroMetabolicPancreatitisTotalNormal Weight for age (275)45 (16.36%)15 (5.45%)1 (0.36%)13 (4.72%)2 (0.72%)2 (0.72%)55 (20%)Low Weight for Age (56)21 (37.5%)9 (16.07%)3 (5.36%)5 (8.93%)2 (5.36%)24 (42.8%)Normal Height for Age (297)50 (16.8%)17 (5.72%)2 (0.67%)14 (4.71%)2 (0.67%)2 (0.67%)61 (20.8%)Low Height for Age (34)16 (47%)7 (20.5%)2 (5.8%)4 (11.6%)2 (5.8%)18 (52.9%)Normal Albumin (301)12 (3.98%)3 (0.99%)02 (0.66%)1 (0.33%)64 (21.3%)Low Albumin (30)24 (66.67%)21 (58.33%)4 (11.1%)16 (44.4%)2 (5.55%)3 (8.3%)15 (50%)Table 5:Comparison of the effect of Nutritional variables in Remission vs Relapse Group with Other StudiesVariablesYu LC et al (1994)Present Study (2011)Remission GroupRelapseRemission GroupRelapseWeight %106.4 ± 29.9109.1 ± 19.323.96 ± 13.4421.1 ± 10.1Height %99.3 ± 4.9104.9 ± 16.1121.17 ± 27.02117.85 ± 22.8Protein Mean6.65 ± 0.886.38 ± 1.12Albumin Mean4.23 ± 0.33.59 ± 0.584.01 ± 0.733.63 ± 0.93

Disclosures:
No relevant conflicts of interest to declare.