# CT-Based body composition and nutritional status as predictors of early-treatment chemotherapy-related infections and hematologic toxicity in pediatric cancer: a prospective study

## TL;DR

This study shows that low muscle mass in children with cancer is linked to higher infection and fever risks during chemotherapy.

## Contribution

Low skeletal muscle mass is newly identified as a predictor of chemotherapy-related toxicity in pediatric cancer patients.

## Key findings

- Low skeletal muscle mass and index were correlated with higher infection and fever risks.
- After adjustment, only low skeletal muscle index remained independently associated with fever.
- Anthropometric parameters and handgrip strength were not associated with toxicity.

## Abstract

Chemotherapy-related toxicity has been associated with body composition, yet there is no consensus on which CT-derived muscle parameter or handgrip strength (HGS) best predicts toxicity in pediatric cancer patients. This study evaluated whether CT-derived body composition parameters and nutritional status independently predict early chemotherapy-related infections and hematologic toxicity in children and adolescents with cancer. In this prospective observational cohort, patients aged 7–18 years undergoing chemotherapy with available CT/PET-CT scans were included. Anthropometric data (weight, height, arm circumference, triceps skinfold thickness) and HGS were collected. At the third lumbar vertebra (L3), skeletal muscle mass (SMM), skeletal muscle index (SMI), total adipose tissue, and muscle radiodensity were measured; psoas area was assessed at L4. Associations were analyzed using χ2 tests and logistic regression adjusted for sex, age, tumor stage, and type. Forty-eight patients were included (mean age 12.6 ± 3.3 years; 64.6% male); 64.6% had hematologic malignancies and 53.6% had advanced disease. Most were classified as having normal nutritional status (50–64.6%). Hematologic (100%) and gastrointestinal (85.4%) toxicities were most frequent. Low SMM and SMI were correlated with a higher risk of infection (OR 4.20; 95% CI 1.23–14.27 and OR 3.92; 95% CI 1.17–13.20, respectively) and fever (OR 4.05; 95% CI 1.21–13.54 and OR 5.82; 95% CI 1.67–20.25, respectively). After adjustment, only low SMI remained independently associated with fever (OR 4.74; 95% CI 1.09–20.61; p = 0.038).

Conclusions: Low muscle mass was associated with early infection and fever-related toxicity, suggesting a role of muscle quantity in immune function during pediatric cancer treatment.
What is Known:• Body composition in children and adolescents changes during chemotherapy is associated with treatment-related toxicity.• Muscle status is crucial for chemotherapy tolerance and treatment response.What is New:• Low skeletal muscle mass was associated with a higher risk of toxicities, including fever.• No association was found between anthropometric parameters, HGS and toxicities, indicating that further studies are needed.

What is Known:

• Body composition in children and adolescents changes during chemotherapy is associated with treatment-related toxicity.

• Muscle status is crucial for chemotherapy tolerance and treatment response.

What is New:

• Low skeletal muscle mass was associated with a higher risk of toxicities, including fever.

• No association was found between anthropometric parameters, HGS and toxicities, indicating that further studies are needed.

The online version contains supplementary material available at 10.1007/s00431-026-06882-x.