Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis

• Published in: Archives of disease in childhood Vol. 71; no. 4; pp. 304 - 310
• Main Authors: Viana, M B, Murao, M, Ramos, G, Oliveira, H M, de Carvalho, R I, de Bastos, M, Colosimo, E A, Silvestrini, W S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-10-1994; BMJ; BMJ Publishing Group LTD
• Subjects: Adolescent; Age; Analysis of Variance; Biological and medical sciences; Body height; Child; Child, Preschool; Children; Developed countries; Developed Nations; Developing countries; Disease-Free Survival; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Infant; LDCs; Leukemia; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Malnutrition; Medical sciences; Multivariate analysis; Nutrition; Nutrition assessment; Nutrition Disorders - complications; Nutritional Status; Pediatrics; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Prognosis; Prospective Studies; Recurrence; Remission; Remission Induction; Risk Factors; Statistical analysis; Tropical medicine; South America; Brazil; America; Human; Prognosis; Lymphoproliferative syndrome; Acute; Nutrition disorder; Malignant hemopathy; Acute lymphocytic leukemia; Multivariate analysis; Malnutrition; Predictive factor; Child
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.71.4.304

One hundred and twenty eight Brazilian children with lymphoblastic leukaemia were intensively treated with a Berlin-Frankfurt-Munich based protocol. More children had a white cell count above 50 x 10(9)/l (31%) then observed in developed countries. After a median follow up of 31 months (11-58 months), the estimated probability of relapse free survival was 41% (7%) for the whole group. After adjustment in the Cox's multivariate model, malnutrition was the most significant adverse factor affecting duration of complete remission. Age above 8 years and high peripheral white cell count were also significant adverse factors. Among the nutritional indices, the height for age and weight for age z scores were both significant, whether the cut off points of z-2 or z = -1.28 were chosen to define malnutrition. A strong statistical association between the two indices was found; the contribution of height for age z score to the prediction of relapse free survival was more significant. Children with height for age z score < -2 had a relapse risk of 8.2 (95% confidence interval 3.1 to 21.9) relative to children with z score > -2. The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries.