Nutritional status at initial presentation in childhood acute lymphoblastic leukemia and its effect on induction of remission.

Abstract

This prospective study was aimed to evaluate the nutritional status at initial presentation in childhood acute lymphoblastic leukemia (ALL) and to ascertain the effects of nutrition on induction of remission. The study was carried out in the Paediatric Haematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh during the period of one year starting from July 2006 to June 2007 on 66 diagnosed case of ALL, age ranged from 01 to 15 year irrespective of sex. The study subjects were stratified into undernourished (35) and well-nourished (31) based on weight for age. Then, protocol based induction of remission was started. Completion of induction was monitored through physical, haematological and morphological examination of bone marrow aspirate. Infection was ruled out clinically and culture sensitivity. Demographic, anthropometric, haematological, clinical and outcome variables were considered in both groups. At initial presentation, 53.03% were undernourished and 46.97% were well-nourished. Male preponderance was found in both groups. Under-nourished children of ALL had significantly decreased weight (p<0.03) and low haemoglobin concentration (p<0.04) at initial presentation. The undernourished children at initial presentation and during induction had about 2 to 3 times more common of culture and clinically proved infection. Undernourished children of ALL required significantly longer duration of induction (p<0.001) and prolonged period of hospital stay (p<0.001). So, it is concluded that under-nutrition is very usual at initial presentation in childhood ALL, are more prone to suffer from infection and thus prolong the duration of induction, hospital stay, even can lead to death. Optimum nutritional support can play a vital role in the outcome of induction of remission in childhood ALL.