Nutritional Status at Diagnosis, During, and After Treatment in Adolescents and Young Adults with Cancer

Haak, Natalie van der; Edwards, Suzanne; Perem, Merike; Landorf, Emma; Osborn, Michael

doi:10.1089/jayao.2020.0197

Cited by 13 publications

(12 citation statements)

References 41 publications

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“…However, in another cohort study of Hispanic children with ALL, researchers found there to be no statistically significant difference in the disease-free survival (DFS) and OS rates between the overweight and obese group and the normal-weight group ( 33 ). Although the risk of overweight or obese status in more common in ALL/LL survivors than in survivors of other tumor types (67% vs. 14%; P = 0.037), a series of future studies are needed to determine whether abnormally increased BMI is clearly associated with the prognosis of children ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of RAS gene mutations in adverse events during first induction chemotherapy in childhood acute lymphoblastic leukemia

Chen¹,

Wu²,

Lv³

et al. 2023

Transl Pediatr

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Background The rat sarcoma virus ( RAS ) pathway controls cell proliferation, differentiation, and apoptosis, which have been implicated in the pathogenesis of various hematological malignancies. Prognostic importance of RAS gene mutation, relatively frequently in childhood acute lymphoblastic leukemia (ALL), has been debated. We aimed to study RAS gene mutation profile and prognosis in 93 children with newly diagnosed ALL. Methods We retrospectively analyzed clinical characteristics, treatment, and outcomes of 93 ALL children during first induction chemotherapy in Anhui Provincial Children’s Hospital under the Chinese Children’s Leukemia Group-acute lymphoblastic leukemia 2018 (CCLG-ALL-2018). All genomic DNA samples were obtained from bone marrow mononuclear cells upon new diagnosis. RAS gene mutation was performed by polymerase chain reaction (PCR). All children were stratified into standard-, medium-, and high-risk groups, and then treated with risk-based regimens according to CCLG-ALL-2018 protocol. Results Of 93 ALL children, 26 (27.9%) were positive for RAS mutation, among whom 19 had N- RAS mutation, 8 had K- RAS mutation, and 1 had a double mutation. The ETV6/RUNX1 fusion gene was the most common genetic alteration (n=16, 17.2%). The most common adverse events during first induction chemotherapy were coagulation abnormalities (n=76, 81.7%), followed by fever (n=71, 76.3%) and alanine transaminase (ALT) elevation (n=34, 36.6%). Compared with negative RAS mutation group, the risk of hyperbilirubinemia was significantly reduced in RAS mutation group (P=0.018), and there was no significant difference in any other adverse events. The average duration of agranulocytosis during first induction chemotherapy was 6 days, and the average duration of agranulocytosis in RAS mutation group and RAS negative group was 6 and 5 days, with no significant difference. Multivariate linear regression analysis showed that in RAS mutation group, when body mass index (BMI) exceeded the median value of this ALL population (BMI >15.38), the risk of agranulocytosis was significantly increased (P=0.003). Conclusions Newly diagnosed ALL in children with RAS mutation is less likely to be associated with fusion gene expression. RAS mutation increases the risk of agranulocytosis duration during first induction chemotherapy, lowers BMI and reduces the risk of hyperbilirubinemia in ALL children.

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Section: Discussionmentioning

confidence: 99%

Analysis of RAS gene mutations in adverse events during first induction chemotherapy in childhood acute lymphoblastic leukemia

Chen¹,

Wu²,

Lv³

et al. 2023

Transl Pediatr

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“…Although less than 10% of AYA patients are malnourished at time of diagnosis, almost half of them experience more than 5% weight loss during cancer treatment [ 14 ]. Not only was our patient severely underweight (Body mass index, BMI 15.9 kg/m 2 ) when first faced with hematologic malignancy, but significant weight loss (14%) was also observed during induction.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Background Adolescents and young adults diagnosed with acute lymphoblastic leukemia are treated according to pediatric-based regimens to achieve better results. However, implementation of intensive chemotherapy protocols in this age group is associated with increased treatment-related toxicities, affecting almost every organ and system. In this case, the focus of our interest was on rather rare entities: steroid-induced psychosis that seldom develops in children and adolescents, and choroid plexus hemosiderosis, infrequently identified as a first sign of iron overload. Case presentation The aim of this paper is to present a challenging case of a 15-year-old Caucasian male patient treated for high-risk acute lymphoblastic leukemia and who experienced various adverse incidents during intensive chemotherapy, thus necessitating a high-quality multidisciplinary approach. Slow minimal residual disease clearance was an additional concerning issue. Induction and re-induction were complicated by steroid-induced hyperglycemia that required multiple-week insulin. During consolidation, acute kidney injury on the basis of chronic kidney disease was verified, demanding subsequent drug dose modifications. By the end of re-induction, after dexamethasone cessation, infrequent steroid-induced psychosis, presented as incoherent speech, aggressive behavior, and mood swings, required intensive psychiatric support. Neurological evaluation of seizures revealed uncommon choroid plexus hemosiderosis by brain magnetic resonance imaging, warranting appropriate selection of iron chelation therapy in the context of preexisting nephropathy. Ultimately, iron deposits of moderate intensity were verified by liver magnetic resonance imaging, while heart tissue remained intact. The early diagnosis and adequate treatment of aforementioned difficult toxicities resulted in complete recovery of the patient. Conclusions Treating adolescents with high-risk acute leukemia and multiple therapy-related morbidities remains a challenge, even in the era of extensive and effective supportive therapy. Superior survival rates might be achieved by prompt recognition of both frequent and rarely encountered adverse episodes, as well as well-timed and appropriate management by a well-coordinated multidisciplinary team.

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“…More specifically, several studies have shown that AYA cancer survivors are at a higher risk of developing cardiomyopathy, stroke and premature ovarian failure compared to AYAs without cancer [ 6 ]. Treatments for cancer may also induce taste and smell disturbances, which can, in turn, alter eating behaviors and lead to nutritional deficiencies, including malnutrition and/or obesity in AYA cancer survivors [ 7 , 8 , 9 , 10 ]. Many AYA cancer survivors also experience fatigue, which can persist for years after treatment [ 1 , 4 ].…”

Section: Adolescent and Young Adult (Aya) Cancer Survivors “Late Effe...mentioning

confidence: 99%

“…In addition to the complex medical and psychosocial challenges described above, AYA cancer survivors are vulnerable to nutritional deficiencies and undernourishment as a consequence of cancer treatments [ 10 ]. A recent study reported that 8% of AYA cancer patients were underweight (BMI < 18.5 kg/m 2 ) before treatment, a number that rose to 20% during treatment [ 10 ]. Malnourishment during cancer treatment is associated with decreased chemotherapy tolerance, increased infection rates and poorer overall survival [ 10 ].…”

Section: Nutritional Challenges In Aya Cancer Survivorsmentioning

confidence: 99%

“…A recent study reported that 8% of AYA cancer patients were underweight (BMI < 18.5 kg/m 2 ) before treatment, a number that rose to 20% during treatment [ 10 ]. Malnourishment during cancer treatment is associated with decreased chemotherapy tolerance, increased infection rates and poorer overall survival [ 10 ]. There is a high prevalence of vitamin D deficiency among patients with cancer of any age and, in particular, in AYAs diagnosed with acute lymphocytic leukemia (ALL) and testicular cancer [ 24 , 25 , 26 ].…”

Section: Nutritional Challenges In Aya Cancer Survivorsmentioning

confidence: 99%

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Food Insecurity and Nutritional Challenges in Adolescent and Young Adult Cancer Survivors in the U.S.A.: A Narrative Review and Call to Action

et al. 2023

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Advancements in cancer treatments over the past several decades have led to improved cancer survival in adolescents and young adults (AYAs, ages 15–39 years). However, AYA cancer survivors are at an increased risk for “late effects”, including cardiovascular, pulmonary and bone diseases as well as fatigue, infertility and secondary cancers. The treatments for cancer may also alter taste, lead to nutritional deficiencies and increase financial burdens that, when taken together, may increase the risk of food and nutrition security in AYA cancer survivors. Furthermore, although AYAs are often merged together in cancer survivorship studies, adolescents and young adults have distinct developmental, psychosocial and pathophysiological differences that may modify their risk of nutritional challenges. In this narrative review and “Call to Action”, rationale is provided for why there is a need to better understand nutritional challenges and food insecurity in AYA cancer survivors as a special population. Then, recommendations for next steps to advance knowledge and policy in this field are provided. In particular, integrating screening for food and nutrition insecurity and enhancing awareness of existing resources (e.g., the Supplemental Nutrition Assistance Program, SNAP) might help AYA cancer survivors combat nutritional deficiencies and reduce late effects while improving their overall survival and quality of life.

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Nutritional Status at Diagnosis, During, and After Treatment in Adolescents and Young Adults with Cancer

Cited by 13 publications

References 41 publications

Analysis of RAS gene mutations in adverse events during first induction chemotherapy in childhood acute lymphoblastic leukemia

Analysis of RAS gene mutations in adverse events during first induction chemotherapy in childhood acute lymphoblastic leukemia

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

Food Insecurity and Nutritional Challenges in Adolescent and Young Adult Cancer Survivors in the U.S.A.: A Narrative Review and Call to Action

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