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Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia

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Abstract

Objective

To evaluate pre-treatment undernutrition, and folate and B12 deficiency in children with acute lymphoblastic leukemia, and their correlation with complications and outcome of induction chemotherapy.

Design

Observational study.

Setting

Tertiary care teaching hospital in Northern India.

Participants

50 children with acute lymphoblastic leukemia.

Procedure

Children were assessed for nutritional status (Weight for age Z-score, serum albumin, folate and B12) at presentation, and were followed-up during induction for bone marrow response, counts and outcome. Folate and B12 were repeated twice at monthly intervals after induction. Univariate and multivariate analyses were done to determine the association of nutritional parameters with the outcome variables.

Results

Baseline undernutrition was observed in 66%, hypoalbuminemia in 32.6%, folate deficiency in 41.3% and B12 deficiency in 36.9% of included children. Significant decline in folate levels was noted on serial assays during chemotherapy (P=0.001). Folate deficient children had higher risk for delayed marrow recovery and counts on day 14 (P=0.007 and P=0.001). Hypoalbuminemia (P=0.04), B12 deficiency (P=0.001) and folate (P=0.03) deficiency were associated with toxic deaths during induction.

Conclusion

Baseline nutritional deficiencies negatively influence the outcome and occurrence of complications during induction chemotherapy in children with acute lymphoblastic leukemia.

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Authors and Affiliations

  1. Departments of Pediatrics, King George’s University, Lucknow, Uttar Pradesh, India

    Sneha Tandon, Nirmalya Roy Moulik & Archana Kumar

  2. Departments of Biochemistry, King George’s University, Lucknow, India

    Abbas Ali Mahdi

  3. Departments of Hemato-pathology, King George’s University, Lucknow, India

    Ashutosh Kumar

Authors
  1. Sneha Tandon
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  2. Nirmalya Roy Moulik
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  3. Archana Kumar
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  4. Abbas Ali Mahdi
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  5. Ashutosh Kumar
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Tandon, S., Moulik, N.R., Kumar, A. et al. Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia. Indian Pediatr 52, 385–389 (2015). https://doi.org/10.1007/s13312-015-0642-x

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  • DOI: https://doi.org/10.1007/s13312-015-0642-x

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