Leukaemia and nutrition I: Malnutrition is an adverse prognostic factor in the outcome of treatment of patients with standard-risk acute lymphoblastic leukaemia

doi:10.1016/0145-2126(89)90043-X

Leukemia Research

Volume 13, Issue 10, 1989, Pages 899-906

https://doi.org/10.1016/0145-2126(89)90043-X Get rights and content

Abstract

A group of 43 pediatric patients with standard-risk ALL were studied. Thirty-seven per cent of them presented with malnutrition at diagnosis. Malnourished children had a significantly worse outcome than well-nourished children. Five-year DFS was 83% for well-nourished children (WNC) and 26% for under-nourished children (UNC) (p < 0.001). Relapses presented more frequently in the bone marrow in UNC than in WNC (56% vs 7%, p < 0.0001). The doses of maintenance chemotherapy had to be reduced in 68% of UNC and 11% of WNC (p < 0.005); the doses of maintenance myelosuppressive chemotherapy (6-MP, oral MTX and hydroxyldaunorubicin) received by UNC were approximately 50% of those received by WNC (p < 0.01). The correlation between malnutrition and compromised treatment was 0.92. Malnutrition might be included as an adverse prognostic factor in acute lymphoblastic leukaemia (ALL).

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Cited by (83)

Protein blend ingestion before allogeneic stem cell transplantation improves protein-energy malnutrition in patients with leukemia
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Citation Excerpt :
Sarcopenia (ie, severe muscle depletion) is an independent prognostic indicator of lower survival in patients with cancer [10]. Furthermore, malnourished patients had significantly worse outcomes than well-nourished patients with leukemia [11]. The degree of protein malnutrition is likely to influence the treatment outcome of leukemia hematopoietic stem cell transplantation (HSCT) and relevant chemotherapeutic outcomes.
Severe protein-energy malnutrition (PEM) and skeletal muscle wasting are commonly observed in patients with acute leukemia. Recently, the ingestion of a soy-whey protein blend has been shown to promote muscle protein synthesis (MPS). Thus, we tested the hypothesis that the ingestion of a soy-whey blended protein (BP) may improve the PEM status and muscle mass in acute leukemia patients. In total, 24 patients from the same treatment group were randomly assigned to the natural diet plus soy-whey blended protein (BP) group and the natural diet only (ND) group. Our data showed that protein and energy intake decreased significantly (P < .05) after transplantation in both groups. In the absence of the BP intervention, dramatic decreases in muscle-related indicators (i.e., anthropometric variables, muscle strength and serum protein) were observed in the majority (>50%) of the patients. However, 66% of the patients who ingested the BP before transplantation showed obvious increases in arm muscle area. The gripping power value (△_post-pre or △_{post-baseline}) was significantly higher in the BP group than in the ND group (P < .05). The ingestion of the BP also increased the levels of serum albumin, globulin and serum total protein to different extents. Notably, the average time to stem cell engraftment was significantly shorter for patients in the BP group (12.2 ± 2.0 days) than for patients in the ND group (15.1 ± 2.9 days). Collectively, our data supported that soy-whey protein can improve PEM status and muscle mass in leukemia patients.
Assessment of early gastrostomy in the treatment of primary malignant bone tumors in children. A report from the French children's oncology study Group GOCE
2017, Revue d'Oncologie Hematologie Pediatrique
Les patients pris en charge en oncologie pédiatrique sont à haut risque de dénutrition protéino-énergétique, notamment lors de traitements comme dans les tumeurs osseuses primitives malignes. De nombreuses conséquences de la dénutrition ont été mises en évidence, pourtant la prise en charge nutritionnelle n’est pas standardisée. Nous avons évalué les bénéfices nutritionnels et la faisabilité d’une nutrition entérale sur gastrostomie précoce, en comparaison à d’autres modes de soutien nutritionnel, lors de la prise en charge de tumeurs osseuses primitives malignes en pédiatrie.
Les caractéristiques de patients atteints de tumeurs osseuses primitives malignes ont été analysées de façon rétrospective, dans le Grand Ouest, de 2003 à 2013. Le recensement des complications de la gastrostomie précoce ainsi que des paramètres nutritionnels des patients a permis l’évaluation de sa faisabilité et de son efficacité. Les données de complications, d’état nutritionnel et de traitement oncologique ont été aussi analysées dans les groupes de patients ayant reçu une nutrition entérale sur sonde nasogastrique et ceux n’en ayant pas reçu.
Une gastrostomie précoce a été posée chez 58 patients, une sonde nasogastrique chez 20 et 60 n’ont bénéficié d’aucun de ces 2 supports de nutrition entérale. La gastrostomie précoce est pourvoyeuse de complications mais mineures et non directement liées à la gastrostomie. Aucune différence entre les trois groupes n’a été mise en évidence sur la fréquence de survenue de complications, le nombre d’hospitalisations ou leurs durées. La gastrostomie précoce a permis d’éviter une dégradation du statut nutritionnel dès la phase préopératoire contrairement aux 2 autres groupes. Aucune différence significative de la survie à 4 ans n’a été retrouvée entre les 3 groupes.
La gastrostomie précoce représente un soutien nutritionnel efficace sans accroissement des complications et sans altération du pronostic oncologique. Son évaluation est à poursuivre sur une cohorte prospective.
Patients in pediatric oncology are at high risk of undernourishment, especially during intensive treatment such as malignant primary bone tumors. Many consequences of malnutrition have been highlighted, yet the nutritional care is not standardized. We evaluated the nutritional benefits and the feasibility of enteral nutrition on early gastrostomy, by comparison to other methods of nutritional support during the treatment of malignant primary bone tumor in children.
The characteristics of patients with malignant primary bone tumors have been retrospectively analyzed in Western regions of France from 2003 to 2013. The census of complications of early gastrostomy and the nutritional parameters of patients (Z-scores weight for height and height for age and body mass index) allowed the evaluation of its feasibility and effectiveness. Complications data, nutritional status and oncology treatment were also analyzed in the groups of patients who received enteral nutrition through nasogastric tube and those who did not receive it.
Early gastrostomy was inserted in 58 patients, a nasogastric tube in 20 and 60 did not receive any of these two nutritional supports. Early gastrostomy is a purveyor of complications (82 for 58 patients) but they are minor and not specific (92.7%). No difference between the three groups has been demonstrated about the frequency of complications, the number of hospitalization or their duration. Early gastrostomy avoided a deterioration of the nutritional status as soon as the preoperative stage unlike the two other groups. No significant difference in survival at 4 years was found between the three groups.
Early gastrostomy is an effective nutritional support which does not increase complications and which does not affect the oncologic prognosis. Its psychological evaluation and nutritional impact in the long term are to be assessed on a prospective group.
Importance of Nutrition in the Treatment of Leukemia in Children and Adolescents
2016, Archives of Medical Research
Citation Excerpt :
However, several groups of investigators in Mexico have made important observations, focusing on children with ALL (23). In 1989 Lobato-Mendizabal and colleagues in Puebla reported that undernourished children, defined by body weight, had much poorer 5-year disease-free survival (26%) than well- nourished children (83%) with standard risk diseases and showed that the former had lower cumulative doses of maintenance chemotherapy and experienced more relapses than the well-nourished patients (24). A decade later a group from Mexico City reported that undernourished children, defined by weight-for-height, had a significantly greater risk of death early in treatment than well-nourished children (25), whereas Gomez-Almaguer and colleagues in Monterrey, Puebla and Mexico City demonstrated that undernourished children were 3.5 times more likely to die during maintenance chemotherapy (26).
Malnutrition has been identified as a prognostic factor in children and adolescents with leukemia.
A review of the data available on this topic has been carried out.
In children and adolescents (0–19 years of age), acute lymphoblastic leukemia (ALL) is the commonest form of cancer worldwide and malnutrition is prevalent in this age group, especially in low- and middle-income countries where most of these young people live. Obesity, measured by body mass index, is associated with poorer survival rates in children and adolescents with ALL and acute myelogenous leukemia in high-income countries. In contrast, undernutrition is linked to poorer survival rates among young people with leukemia in low- and middle-income countries.
Why the oncologist should consider the nutritional status of the elderly cancer patient
2015, Nutrition
Citation Excerpt :
However, all proposals of definitions of cancer cachexia and several clinical scores that quantify the risk associated with malnutrition include weight loss in their formulations. Data from literature show malnutrition evaluated as weight loss [16–37] or low bioelectrical impedance phase angle [38–45] or depletion of protein [46] of fat [47] or as low prognostic nutritional index [48,49], poor MNA [50], or severe Glasgow Prognostic Score [51] or are associated with a poor prognosis (Table 1). These series generally included patients of any age but some studies regarded only elderly patients [7,27,43].
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2013, Critical Reviews in Oncology/Hematology
This review focuses on the nutritional support of the non-surgical cancer patient. The following topics are reviewed: cancer cachexia (definition and staging, prevalence and impact on clinical outcome); nutritional screening to identify potential candidates for nutritional support; nutritional requirements in terms of macro-and micro-nutrients of the advanced cancer patient.
Finally, the indications and results of nutritional support are presented with a special focus on the following issues: routes of delivering nutritional support, the use of standard or n−3 fatty acids-enriched oral nutritional supplements during radiation therapy and/or chemotherapy, tube feeding during RT (with/without chemotherapy), parenteral nutrition during chemotherapy, nutritional support during hematopoietic stem cell transplantation, (home) enteral or total and supplemental parenteral nutrition in the incurable patient.
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^☆: This work was supported in part by the Consejo Estatal de Ciencia y Tecnología de Puebla, México.

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Leukaemia and nutrition I: Malnutrition is an adverse prognostic factor in the outcome of treatment of patients with standard-risk acute lymphoblastic leukaemia☆

Abstract

Blood

Lancet

Lancet

Blood

Blood

Lancet

Blood

Blood

Blood

Am. J. Med.

Am. J. Med.

Blood

Lancet

A score of diagnosis for predicting length of remission in childhood acute lymphoblastic leukaemia

Br. J. Cancer

Acute lymphoblastic leukemia

Semin. Hemat.

Prognostic factors and therapy in acute lymphoblastic leukemia of childhood: CCG-141

Cancer

Acute leukemia: Biology and treatment

Ann. intern. Med.

Disappearance of the predictive value of prognostic variables in childhood acute lymphoblastic leukemia: A report from Childrens Cancer Study Group

Cancer

Prognosis of black children with acute lymphoblastic leukemia

Med. Pediat. Oncol.

Mediastinal mass and prognosis in acute lymphoblastic leukemia

Initial features and prognosis in 363 children with acute lymphoblastic leukemia

Cancer

The morphologic classification of acute lymphoblastic leukemia in childhood

Am. J. clin. Path.

Subclassification of acute lymphoblastic leukemia in children: Analysis of the reproducibility of morphological criteria and prognostic implications

Br. J. Haemat.

Leucemia aguda linfoblastica: Aplicacion del “score” del grupo F.A.B. y analisis del valor pronostico del examen morfologico de la medula osea en pacientes

Sangre

Acute lymphocytic leukemia: Correlation of clinical features with immunocytochemical classification

Am. J. Hemat.

Assessment of the interrelationship of prognostic factors in childhood acute lymphoblastic leukemia: A report from children's cancer study group

Am. J. Pediat. Hemat. Oncol.