Impact of Malnutrition on Treatment Outcome of Paediatric Acute Myeloid Leukemia.

OBJECTIVE

To analyse the distribution of malnutrition in paediatric acute myeloid leukaemia (AML) and its effect on treatment outcome and survival in Pakistani children.

STUDY DESIGN

Descriptive, analytical study.

PLACE AND DURATION OF STUDY

Department of Paediatric Oncology, Combined Military Hospital (CMH), Rawalpindi, Pakistan from January 2012 to January 2019.

METHODOLOGY

Data of all newly registered cases of paediatric AML was analysed to see the association of nutritional status according to Z-score classification and treatment outcome. The outcome was divided into disease-free and overall survival.

RESULTS

A total of 206 cases, including 130 (63.1%) boys and 76 (36.9%) girls were evaluated. The mean age at diagnosis was 5.96 ± 3.58 years. Pallor was the most common clinical feature in 172 (83.5%) followed by fever in 158 (76.7%) cases. AML M-2 was the most frequent French-American-British (FAB) subtype in 94 (45.6%) cases. Majority of the patients (n = 128, 62.1%) were well nourished; and 46 (22.3%) and 32 (15.5%) were moderately and severely malnourished, respectively. Disease-free survival (DFS) was 43.0%, 32.6% and 21.9% in well nourished, moderately malnourished and severely malnourished patients, respectively (p=0.022). Overall survival (OS) was 43.8%, 39.1% and 21.9% in well nourished, moderately malnourished and severely malnourished patients, respectively (p=0.012).

CONCLUSION

Malnutrition adversely affects the treatment outcome in paediatric AML. It is significantly associated with increased treatment-related mortality, mainly due to infection and decreased disease-free and overall survival. Key Words: Paediatric acute myeloid leukaemia, Mortality, Nutritional status, Weight-for-age, Z score, Pakistan.