Impact of malnutrition on febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy

Abstract

Background Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents. Febrile Neutropenia (FN) is a medical emergency on ALL that often leads to death. Nutrition status assessment on ALL patient is important because malnutrition can reduce the tolerance of chemotherapy, increase incidence of infection and decrease survival rate.
 Objectives To assess malnutrition as a risk factor for FN in children with ALL.
 Methods This case-control study was performed at Sardjito Hospital, Yogyakarta on patients aged 1 month to 18 years diagnosed with ALL and undergoing induction phase chemotherapy between January 2013 and December 2015. The case and control subjects were children with and without FN, respectively. Febrile neutropenia was confirmed by patients temperature above 38ºC at one measurement and a peripheral neutrophil count of less than 1,000/mm3. Malnutrition was defined as body weight-for-height was between -2 and <-3 standard deviation. Subjects were included using simple random sampling.
 Result Bivariate analysis showed a significant correlation between malnutrition and FN (OR 2.62; 95%CI 1.07 to 6.45; P=0.03). However, there was no inverse correlation between socioeconomic status and FN (OR 1.1; 95%CI 0.42 to 2.41; P=0.83). There was no correlation between nutritional status and duration of FN (P= 0.48). 
 Conclusion Malnutrition is a risk factor for FN in children with acute lymphoblastic leukemia.

Malnutrition as a predictor of adverse outcomes of febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy

“…13 However, Agnes et al found that socioeconomic status was not statistically significant (p=0.83) for FN. 14 In our study, analysis of nutritional status as a risk factor for FN based on anthropometric indices was found statistically significant for, weight for height (≤5 years) p=0.036, OR=0.24 (95% CI .06-.958), weight for age p=0.006, OR=0.23 (95% CI=0.07-0.67), but for BMI for age (>5 years) p=0.28, OD=0.28 (95% CI=0.02-3.19), and height for age p=0.513, OD=0.66 (95% CI-0.18-2.33). In this study, nutritional status was associated with adverse outcomes of FN, but we did not find it as a strong risk factor, as the odds ratio was not significant.…”

“…9 Although malnutrition is a common occurrence in children with ALL in our country, there is a dearth of studies exploring the role of nutritional status in patients suffering from ALL, as malnutrition increases the incidence of infection and decreases the survival rate. 10 Thus, this topic was selected to assess the effect of malnutrition on adverse outcomes among ALL patients suffering from FN.…”

A challenging case of an adolescent and young adult patient with high-risk acute lymphoblastic leukemia: the need for a multidisciplinary approach: a case report

“…However, an association to hyperglycemia was not apparent [ 8 ]. Nevertheless, malnutrition has been repeatedly described as a predisposing factor for FN [ 11 – 13 ].…”

Microbiological profiles and prognostic factors of infection mortality in febrile neutropenic children with malignancy

“…Additionally, malnutrition causes hematopoiesis, anemia, leukopenia, significant decreases in bone marrow, including IL-6 and TNF-α production, as well as hormonal disturbances. 23,24 Nevertheless, we need to consider the wide confidence interval of the nutrition groups relative risk and seemingly protective effect of obesity as the result of unbalanced numbers of subjects compared to their normal weight counterpart. Therefore, the RR needed to be interpreted carefully.…”