Malnutrition as a predictor of adverse outcomes of febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy

Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition impairs immune function, leading to increased incidence of infection, poor quality of life, as well as death. Febrile neutropenia (FN) has a high prevalence in children with acute lymphoblastic leukemia (ALL) and a poor outcome as well.Methods: This prospective observational study was done in the department of pediatrics hematology and oncology (PHO), BSMMU, from January 2021 to October 2021. A total of 60 patients of ALL were selected purposively. Patients were evaluated by taking anthropometric parameters before getting chemotherapy and were prospectively followed up for the development and outcome of FN until recovery. Statistical analysis was performed by using SPSS (Statistical package for the social sciences) for Windows version 26.0.Result: Analysis of nutritional status as a risk factor for FN based on anthropometric indices, was found statistically significant for, weight for height (?5 years) p=0.036, OR=0.24 (95% CI= 0.06-0.958), weight for age p=0.006, OR=0.23 (95% CI=0.07-0.67), but for BMI for age (>5 years) p=0.28, OD=0.28 (95% CI=0.02-3.19), and height for age p=0.513, OD=0.66 (95% CI=0.18-2.33) no statistically significant value was found. In this study, we found mortality rate was 15%. The mortality rate was significantly worse (27.3%) for patients who were malnourished at diagnosis as compared to those who were well nourished (7.9%) at diagnosis.Conclusions: FN and its complications are more common in malnourished children with ALL. Malnutrition is associated with adverse outcomes of FN in children with ALL.

Evaluation of aprepitant as an add-on therapy for prevention of chemotherapy induced nausea and vomiting in children

Background: Chemotherapy-induced nausea and vomiting (CINV), represents a common and distressing side effect associated with antineoplastic treatment in pediatric patients. Aprepitant, a selective neurokinin-1 receptor antagonist, is recommended for preventing CINV in combination with a standard antiemetic regimen in children undergoing chemotherapy. This study aimed to evaluate the effectiveness of aprepitant as an add-on therapy to the standard antiemetic regimen for the prevention of CINV in children.Methods: This randomized control study was conducted in the BSMMU, Dhaka, Bangladesh from February 2020 to October 2020. Forty-six children with malignancy undergoing chemotherapy were divided into two arms: the Aprepitant arm (23 patients receiving granisetron, dexamethasone, and aprepitant) and the control arm (23 patients receiving Granisetron and Dexamethasone). Data were analyzed using SPSS version 22.0.Results: The complete response rates for the aprepitant versus control arm during the acute and overall phase were 82% vs. 40% (p=0.003) and 65% vs. 26% (p=0.008), respectively. However, a higher percentage of patients who achieved complete response in the delayed phase was also observed, though statistically not significant (65% vs 40%, p=0.077). In the acute phase, there was a significant reduction in mild to moderate vomiting in the Aprepitant arm as compared to the control arm (p=0.01). In the overall phase, 35% of patients in the Aprepitant arm had mild to moderate vomiting as compared to 74% in the control group (p=0.027). No major adverse effects were reported by patients or caregivers.Conclusions: Adding Aprepitant to the standard antiemetic regimen was effective and safe in preventing CINV, especially in the acute phase, in pediatric patients receiving the moderately and highly emetogenic chemotherapy (HEC).