Effect of nutritional support on therapy-related side effects in acute lymphoblastic leukemia children undergoing chemotherapy / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the changes in nutritional status changes of pediatric acute lymphoblastic leukemia (ALL) patients before and after chemotherapy and to evaluate the effects of enteral nutritional support on the states of nutrition and complication of chemotherapy.Methods Sixty-two newly diagnosed ALL patients from Novem-ber 2012 to December 2013 in Center of Hematology,Beijing Children's Hospital Affiliated to Capital Medical University were enrolled in this study.Patients were randomly assigned into an intervention group and a control group.During the induction and the early consolidation chemotherapy,the control group was given routine low fat diet routinely,and the intervention group was given Nestle peptamen [20 mL/(kg · d)] as the enteral nutritional support,meanwhile the routine low fat diet was also given.Changes in the nutritional status before and after chemotherapy and effectiveness of nutritional complementary therapy for preventing the chemotherapy complications were analyzed.Results (1) Basic informationthere was no significant difference in age,gender,risk group,anthropometry,albumin and pre-albumin level between 2 groups before chemotherapy.(2)Nutritional statusthe rate of malnutrition was 11.3 ％,and skinniness cases under 5 years of age occupied 10.0％.In the control group,the Z scores of W/H (weight-for-length/height,t =3.160,P =0.040),the Z scores of BMI (body mass index,t =3.490,P =0.010) and the albumin level(t =-1.805,P ＜0.001) decreased after chemotherapy,and the difference was statistically significant.On the other hand,the Z scores of W/H and BMI kept stable after chemotherapy in the intervention group,the albumin level raised from (40.53 ±3.96) g/L to (44.36 ± 3.31) g/L (t =-4.500,P ＜ 0.001) and the pre-albumin level raised from (126.55 ± 39.28) g/L to (189.55 ± 51.81) g/L(t =2.710,P =0.010),which was of statistical difference.The albumin level(t =5.020,P ＜ 0.001),pre-albumin level (t =3.036,P =0.040) and the Z scores of W/H (t =2.790,P =0.010),BMI (t =3.370,P ＜ 0.001),weight for age (W/A,t =2.830,P =0.010) were all higher in the intervention group,and the differences in statistical significance were found.(3)Side effects of chemotherapypatients in the intervention group had higher hemoglobin (t =2.070,P =0.043) and platelet (Z =-2.19,P =0.033) level during the chemotherapy which induce less platelet [(0.50 ± 1.00) U vs (2.00 ± 2.00) U ; Z =-3.53,P =0.003] and red blood cells [(3.87 ± 2.01) U vs (5.25 ± 1.87) U ;t =-2.810,P =0.007] transfusion.Period of neutrophil deficiency [(15.67 ± 8.85)d vs (25.94 ±8.72) d;t =-4.601,P ＜0.001]was also shorter than that in the control group.Other complications had no difference between two groups exclude mild liver function abnormality was found more in the controls(x2 =6.680,P =0.010).(4)Safetythe complete remission rate 15 days after chemotherapy was 83.3％ in the intervention group and 81.2％ in the control group (x2 =0.046,P =0.830).All patients got complete remission on day 33.There was no significant difference.No pancreatitis happened in both groups during the chemotherapy.Conclusions Malnutrition rate is high among newly diagnosed ALL pediatric patients,and the nutritional status will deteriorate during the chemotherapy.Enteral nutritional support contributes to maintaining the stability of nutritional status.Enteral nutritional support improves the tolerance of hematopoietic system to chemotherapy.The effect for other complications remains to be confirmed by more extensive study in future.Nestle peptamenas enteral nutritional support productions are safe for ALL patients undergoing chemotherapy.