Longitudinal Assessment of Nutritional Status in Adults with Acute Leukemia.

RATIONALE: The nutritional status of patients with acute leukemia (AL) is frequently impaired during intensive induction chemotherapy. Previous studies have suggested that malnutrition may have an adverse effect on prognosis. The aim of the study was to determine the prevalence of malnutrition during induction chemotherapy treatment and its impact on the outcome.

METHODS: The study was performed over a period of 18 consecutive months. Acute leukemia patients were prospectively studied during first remission induction chemotherapy. The Subjective Global Assessment (SGA), anthropometric and laboratory data were determined at diagnosis and on day 30 of the treatment in order to evaluate nutritional status. Patients were prospectively followed until 60 days after diagnosis. An analysis was made including demographic data, nutritional assessment, albumin, complications, rate of complete remission (CR), rate of early mortality (EM) and length of hospital stay (LOS).

RESULTS: 32 patients (18 men, 14 women) were included; median age 31 years (range 15–62); 16 with myeloid leukemia, 13 with lymphocytic leukemia and 3 with hybrid leukemia. The median of body mass index (BMI) was 25 kg/m² (18.3–41.7); triceps skinfold (TSF) 16.5 mm (7–42); albumin 3.24 g/dL (1.98–4.18). At diagnosis, the prevalence of malnutrition was 59% according to the SGA (moderately and severely malnourished) and increased to 90% on day 30, (p<0.05). We obtained initial CR in 22 patients (69%), the mortality rate due to post-chemotherapy aplasia (EM) in the prospective cohort was 9%. Patients with deterioration of the nutritional status had longer LOS in comparison with those patients well nourished (15.61 vs. 9.68 p<0.05). They also needed antibiotics for a longer time (16 vs. 10 days, p< 0.05). Nutritional status was not associated with CR rate or EM rate.

CONCLUSIONS: The high incidence of malnutrition at the time of diagnosis and during chemotherapy indicate the importance of nutritional status evaluation. Malnutrition in AL is caused by chemotherapy side effects and/or the disease itself, during this period intensive supportive care, including nutritional therapy is required.