Background: Nutritional status in children with acute lymphoblastic leukemia (ALL) is important. The impact of malnutrition at diagnosis on the induction response is still controversial. This study aimed to assess the prevalence of malnutrition in children with ALL at the time of diagnosis and to evaluate its relation with patients' characteristics and response to the induction therapy. Methods: A prospective study was conducted on 43 newly diagnosed ALL patients, aged 2-18 years, from January 2020 to November 2020. All patients were treated according to the modified St. Jude Total XV protocol. Response evaluation was done by bone marrow aspiration and minimal residual disease (when available). The nutritional assessment was done at the presentation by the STRONG kids screening tool and anthropometrics done were weight for age (WFA), body mass index for age (BMI for age), and arm anthropometry (mid-upper arm circumference/ triceps skinfold thickness (MUAC/TSFT).
Results: Median age was 6 years, 55.8% were males, 79% lived in rural areas, and 69.8% belonged to the moderate socioeconomic status category. The rapid early response was achieved in 79.1% and 90% had complete remission post-induction. About one-third had high malnutrition risk. The prevalence of undernutrition was 9.3% by WFA, 32.5% by BMI/A, 67.4% by MUAC, and 30.2% by TSFT. Patients with undernutrition had a significant association with malnutritional risk (p=0.006) and induction failure (p=0.031).
Conclusion: There was a high prevalence of malnutrition in pediatric ALL patients in South Egypt. Undernutrition had a significant association with malnutrition risk and induction failure.