[Leukemia and malnutrition. III. Effect of chemotherapeutic treatment on the nutritional state and its repercussion on the therapeutic response of patients with acute lymphoblastic leukemia with standard risk].

This is the third part of a series of papers dealing with the relationship between malnutrition and poor prognosis of patients with standard-risk acute lymphoblastic leukaemia (ALL). The first part shows that undernourishment is an adverse prognostic factor in the outcome of treatment of patients with ALL inasmuch as malnourished children, due to diminished bone marrow reserve, receive approximately 50% of the optimal doses of so-called "maintenance" chemotherapy, thus leading into frequent bone marrow leukaemic relapses and into a shortened disease-free survival--DFS--(5 year DFS was 83% for well nourished children and only 26% for undernourished children, p less than 0.001). The second part demonstrates that the delivery of sub-optimal doses of myelosuppressive maintenance chemotherapy is by itself, an adverse prognostic factor in the outcome of treatment of children with ALL: five year disease free-survival was 65% and 7% for children receiving either optimal or sub-optimal doses of ablative maintenance chemotherapy (p less than 0.001); accordingly, suboptimal doses of chemotherapy were delivered mainly in undernourished children, due to the abnormally low bone marrow reserve. This third part deals with two additional points: the degree of undernourishment as related to the prognosis and the changes in the nutritional status along with the anti-leukaemic chemotherapy, together with its relationship to the prognosis. In a group of 43 children with standard-risk ALL, we have found that those with a mild to moderate degree of undernourishment do better than those with severe forms of malnutrition (2 year-DFS was 50% and 25% respectively, p less than 0.02), but significantly worse than those with normal nourishment status.(ABSTRACT TRUNCATED AT 250 WORDS)