# Evaluation of Nutritional Status During Induction Chemotherapy in Patients With Acute Leukemia

## TL;DR

This study found that children with acute leukemia undergoing chemotherapy in India often experience worsening malnutrition, which is linked to higher complications and worse outcomes.

## Contribution

The study provides new insights into the progression of malnutrition and its impact on outcomes in acute leukemia patients during chemotherapy in a resource-limited setting.

## Key findings

- Undernutrition worsened significantly during induction chemotherapy in both underweight and healthy weight patients.
- Lower serum albumin and iron levels at admission correlated with higher mortality and poor prognosis.
- Underweight patients had higher morbidity compared to healthy weight patients during treatment.

## Abstract

Background: Malnutrition is often prevalent in most of the children living in resource-limited countries. This study aimed to evaluate the occurrence of malnutrition and micronutrient deficiency in patients with acute leukemia undergoing induction chemotherapy and to report the various outcomes regarding complications and remission rates.

Materials and methods: This prospective observational study was conducted at the hematology wards of All India Institute of Medical Sciences (AIIMS), New Delhi from February 2018 to August 2019. The study involved children and adolescents aged two to 20 years, of any gender, diagnosed with acute leukemia, and undergoing induction chemotherapy. Baseline characteristics were recorded along with nutritional parameters like micronutrients at admission, two weeks, and four weeks (at the end of induction).

Results: A total of 64 patients were enrolled, and the majority of them were males (67.18%). Based on body mass index (BMI), patients were categorized into underweight (45.31%), healthy weight (51.56%), and overweight (3.13%) groups. B-cell acute lymphoblastic leukemia (B-ALL) was the most common diagnosis. There was a noticeable trend of worsening undernutrition in both underweight and healthy weight groups. The mean BMI decreased significantly from 16.71 kg/m2 at admission to 16.05 kg/m2 and 16 kg/m2 at weeks two and four, respectively (P=0.0001). Serum albumin levels at admission and after two weeks showed a strong correlation with mortality (P<0.001) and a poor prognosis (P<0.001). Serum iron levels dropped significantly from 165.5 ng/mL (on admission) to 126 ng/mL at two weeks (P=0.001), and total iron binding capacity (TIBC) values also decreased from 231.5 mcg/dL to 195.5 mcg/dL at two weeks (P=0.04). Additionally, the underweight category experienced higher morbidity compared to the healthy weight group (65.52% vs. 39.39%; P=0.043).

Conclusion: The study highlights the critical importance of assessing and addressing the nutritional status of acute leukemia patients upon admission, as undernourished individuals exhibited higher morbidity and required more chemotherapy dose adjustments.