Assessment Of Nutritional Status And Its Correlation With Therapeutic Effect In Children With Acute Lymphoblastic Leukemia

Objective:By assessing the nutritional status of children with acute lymphoblastic leukemia（ALL）during induction remission treatment,analyzing the impact of nutritional status at the initial diagnosis on the early curative effect and related adverse reactions to chemotherapy,and exploring the relationship between nutritional status and serum protein in children with ALL,to provide a basis for further understanding the nutritional status of children with ALL,reduce the incidence of adverse reactions during chemotherapy,and improve early treatment effects and long-term quality of life.Methods:By consulting medical records,we obtained 55 children’s data who with ALL in our unit.The data includes general clinical data（gender,age,height,weight,body mass index（BMI）,ALL risk stratification）,laboratory biochemical data（albumin,prealbumin）,efficacy data（bone marrow remission status on day 15 and minimal residual disease（MRD）on day 33）,chemotherapy-related adverse reaction data（infection,Liver damage,mucosal damage,gastrointestinal reactions,etc.）.According to the BMI level,the children were divided into three groups:malnutrition,normal nutrition and overnutrition.To understanding the nutritional status of ALL children during induction treatment,analyze the effect of nutritional status at the first diagnosis on early curative effect and chemotherapy-related adverse reactions,and explore the relationship between nutritional status and serum protein.Statistical methods such as chi-square test,Fisher’s exact probability method,one-way analysis of variance and Logistic regression were used for statistical analysis,and P<0.05 was statistically significant.Results:1.Among the 55 children with ALL,31 males（56.4%）and 24 females（43.6%）,The male to female ratio was approximately 1.3:1;The age of initial diagnosis was 2-15 years old,and the median age was 7 years old,including38 children aged 2-10 years old（69.1%）and 17 children aged≥10 years old（30.9%）.At the time of initial diagnosis,11 patients（20.0%）were malnourished,28 patients（50.9%）were normal nourished,and 16 patients（29.1%）were overnourished（obese/overweight）.At the end of induction therapy,13（23.6%）were malnourished,28（50.9%）were normal nourished,and 14（25.4%）were overnourished（obese/overweight）.During induction therapy,the incidence of malnutrition in ALL children increased from 20.0%to 23.6%.The overnutrition rate was reduced from 29.1%to 25.4%.There was no statistical significance between nutritional status and age and sex at first diagnosis（P>0.05）.2.Before and after induction remission treatment,there were no statistically significant differences in nutritional status and serum ALB and PA levels among the three groups.The F values were:F_ALB=2.425 and F_PA=0.695before induction remission treatment;After induction therapy,F_ALB=0.682 and F_PA=2.012;P>0.05.Spearman was used to analyze the correlation between BMI and serum protein before and after induction therapy.The results showed that there was no significant correlation between BMI and serum ALB（r=0.165,P=0.230）and PA（r=0.066,P=0.631）before the induction therapy for ALL.After the ALL induction,there was no significant correlation between BMI and serum ALB（r=-0.137,P=0.318）and PA（r=-0.259,P=0.210）.3.The Chi-square test was used to compare the difference between nutritional status and bone marrow morphology on the 15th day among the three groups,and the results showed no statistical significance（P=0.841）.There was a statistically significant difference between the nutritional status of the three groups and the MRD of day 33（P=0.027）.Pairwise comparison showed that there was a statistically significant difference in the MRD of day 33 between the overnutrition group and the normal nutrition group（P=0.006<0.016）.Multivariate Logistic regression analysis was conducted with MRD at day 33 as the dependent variable and nutritional status,risk and immunotyping as the independent variables.The results showed that nutritional status and risk were the risk factors for MRD positive at day 33（P=0.006,0.000）.4.There was no significant difference between different nutritional status and infection（χ2=1.068）,liver injury（χ2=3.421）,mucosal injury（χ2=0.928）and gastrointestinal reaction（χ2=0.466）in ALL children at initial diagnosis,P>0.05.Conclusions:1.The prevalence of malnutrition in children with ALL increased from20.0%to 23.6%during induction therapy.2.Overnutrition at the first diagnosis is a risk factor for positive MRD on the 33rd day,and inappropriate nutritional status（BMI）at the first diagnosis can be used as a Risk factors for early efficacy.3.The grouping of nutritional status（BMI）in children with ALL during induction therapy was not related to serum albumin and prealbumin levels,and serum protein（ALB,PA）was more suitable as an auxiliary reference index for nutritional assessment.4.The incidence of chemotherapy-related adverse reactions in children with ALL who were malnourished or overnourished at the time of initial diagnosis was higher than that in children with normal nutrition,but it was insignificant after statistical processing,and It still needs further research.