Impact of malnutrition on febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy
Abstract
Background Acute lymphoblastic leukemia (ALL) is the most common malignancy in children and adolescents. Febrile Neutropenia (FN) is a medical emergency on ALL that often leads to death. Nutrition status assessment on ALL patient is important because malnutrition can reduce the tolerance of chemotherapy, increase incidence of infection and decrease survival rate.
Objectives To assess malnutrition as a risk factor for FN in children with ALL.
Methods This case-control study was performed at Sardjito Hospital, Yogyakarta on patients aged 1 month to 18 years diagnosed with ALL and undergoing induction phase chemotherapy between January 2013 and December 2015. The case and control subjects were children with and without FN, respectively. Febrile neutropenia was confirmed by patients temperature above 38ºC at one measurement and a peripheral neutrophil count of less than 1,000/mm3. Malnutrition was defined as body weight-for-height was between -2 and <-3 standard deviation. Subjects were included using simple random sampling.
Result Bivariate analysis showed a significant correlation between malnutrition and FN (OR 2.62; 95%CI 1.07 to 6.45; P=0.03). However, there was no inverse correlation between socioeconomic status and FN (OR 1.1; 95%CI 0.42 to 2.41; P=0.83). There was no correlation between nutritional status and duration of FN (P= 0.48).
Conclusion Malnutrition is a risk factor for FN in children with acute lymphoblastic leukemia.
References
Ward E, DeSantis C, Robbins A., Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin. 2014,64:83–103. https://doi.org/10.3322/caac.21219 PMid:24488779
Katz AJ, Chia VM, Schoonen WM, Kelsh MA. Acute lymphoblastic leukemia: An assessment of international incidence, survival, and disease burden. Cancer Causes Control. 2015;26:1627–42. https://doi.org/10.1007/s10552-015-0657-6 PMid:26376890
Supriyadi E, Widjajanto PH, Purwanto I, Cloos J, Veerman AJ, Sutaryo S. Incidence of childhood leukemia in Yogyakarta, Indonesia, 1998-2009. Pediatr Blood Cancer. 2011;57:588-93. https://doi.org/10.1002/pbc.23109 PMid:21681925
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52:56-93. https://doi.org/10.1093/cid/ciq147 https://doi.org/10.1093/cid/cir073 PMid:21258094
Biswal S, Godnaik C. Incidence and manajement of infection in patients with acute leukemia following chemotherapy in general wards. Ecancermedicalscience. 2013;7:310. PMid:23634180 PMCid:PMC3634721
Sanboonrat P, Chainansamit S, Sriraksa K. Febrile neutropenia in children with acute leukemia. Khon Kaen Med J. 2009;33:2–8.
Sudewi NPS, Tumbelaka AR, WE. Kejadian demam neutropeni pada keganasan. Sari Pediatr. 2007;368–72.
Asturias EJ, Corral JE, Quezada J. Evaluation of six risk factors for the development of bacteremia in children with cancer and febrile neutropenia. Curr Oncol. 2010;17:59–63. PMid:20404980 PMCid:PMC2854640
Tamam M., Satrio P. Faktor risiko terjadinya demam neutropeni pada anak leukemia limfoblastik akut. Sari Pediatr. 2013;15:39–45.
Alexandre J, Gross-Goupil M, Falissard B, Nguyen ML, Gornet JM, Misset JL, et al. Evaluation of the nutritional and inflammatory status in cancer patients for the risk assessment of severe haematological toxicity following chemotherapy. Ann Oncol. 2003;14:36–41. https://doi.org/10.1093/annonc/mdg013 PMid:12488290
Linga VG, Shreedhara AK, Rau ATK, Rau A. Nutritional assessment of children with hematological malignancies and their subsequent tolerance to chemotherapy. Ochsner J. 2012;12:197–201. PMid:23049455 PMCid:PMC3448240
Martakoesoemah M. Hubungan status nutrisi awal dengan kejadian demam neutropeni pada pasien leukemia limfoblastik akut anak yang menjalani kemoterapi fase induction. [Cited 2016 May]. Available from: http://respirator.unpad.ac.id/14709/1.pdf.
Guriek Gökçebay D, Emir S, Bayhan T, Demir HA, Gunduz M., Tunc B. Assessment of nutritional status in children with cancer and effectiveness of oral nutritional supplements assessment of nutritional status in children. J Pediatr Hematol Oncol. 2015;32:423–32.
Chandra RK. Nutrition and the immune system from birth to old age. Eur J Clin Nutr. 2002;56:Suppl 3:S73–6. https://doi.org/10.1038/sj.ejcn.1601492 PMid:12142969
Lobato-Mendizabal E, Lopez-Martinez B, Ruiz-Arquelles G. A critical review of the prognostic value of the nutritional status at diagnosis in the outcome of therapy of children with acute lymphoblastic leukemia. Rev Invest Clin. 2003;55:31–5. PMid:12708161
WHO child growth standars: lenght/height-for age, weight-for-age, weight-for-lenght, weight-for-height and body mass index-for age: methods and development. Geneva:WHO; 2006.
Sjarif DR. Prinsip asuhan nutrisi pada anak. In: Sjarif DR, Lestari ED, Mexitalia M, Nasar SS, editors. Buku ajar nutrisi pediatrik dan penyakit metabolik. 1st Edition. Jakarta; Ikatan Dokter Anak Indonesia: 2011.p. 37-9.
Permono B, Ugrasena IGD. Leukemia akut. In: Permono B, Sutaryo, Ugrasena IGD, Windiastuti E, Abdulsalam M, editors. Buku ajar hemato-onkologi anak. 4th Edition. Jakarta; Ikatan Dokter Anak Indonesia: 2012.p. 240-1.
Dulisse B, Li X, Gayle JA, Barron RL, Ernst FR, Rothman KJ, et al. A retrospedctive study of the clinical and economic burden during hospitalizations among cancer patients with febrile neutropenia. J Med Econ. 2013;16(6):720-35. https://doi.org/10.3111/13696998.2013.782034 PMid:23452298
Hafiz MG, Mannon MA. Nutritional status at initial presentation in childhood acute lymphoblastic leukemia and its effect on induction of remission. Mymensingh Med J. 2008;17:Suppl 2:S46-51. PMid:18946451
Kholisa IL, Haryanti F, Lusmilasari L. Status gizi dan kejadian infeksi pada pasien Leukemia Limfoblastik akut (ALL) selama pengobatan fase induction. JIK. 2006;1:5–9.
Barber MD, Ross JA, Fearon K. Cancer cachexia. J Surg Oncol. 1999;8:133–41. https://doi.org/10.1016/S0960-7404(99)00045-6
Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nuts. 2005;9:Suppl 9:S51–63. https://doi.org/10.1016/j.ejon.2005.09.007 PMid:16437758
Sala A, Antilon F, Pencharz P, Barr P, AHOPCA Consortium. Nutritional status in children with cancer: A report from the AHOPCA workshop held in Guatemala City, August 31-September5, 2004. Pediatr Blood Cancer. 2004;45:230-6. https://doi.org/10.1002/pbc.20371 PMid:15920776
Argile JM. Cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9:S39-50. https://doi.org/10.1016/j.ejon.2005.09.006 PMid:16437757
Olson J. Belajar mudah farmakologi.1st edition, EGC. Jakarta.2005. p15-20
Neumann S, Krause SW, Maschmeyer G, Schiel X, von Lilienfold-Toal M. Primary prophylaxis of bacterial infections and Pneumocystis jirovecii pneumonia in patients with hematological malignancies and solid tumors: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol. 2013;92:433-42. https://doi.org/10.1007/s00277-013-1698-0 PMid:23412562 PMCid:PMC3590398
Green H, Paul M, Vidal L, Leibovici L. Profiphylaxis of Pneumocystis pneumonia in immunocompromised non-HIV-infected patients: systematic review and metaanalysis randomized controlled trials. Mayo Clin Proc. 2007;82:1052-9. https://doi.org/10.4065/82.9.1052 PMid:17803871
Sepkowitz KA. Pneumocytis carinii pneumonia among patients with neoplastic disease. Semin Respir Infect. 1992;7:114-21. PMid:1439321
ὂdzemir N, Tὓysὓz G, çelik N, Yantri L, Erginὂz E, Apak H, et al. Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience. Turk Pediatri Ars. 2016;51:79-86. https://doi.org/10.5152/TurkPediatriArs.2016.2757 PMid:27489464 PMCid:PMC4959745
Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, et al. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr. 1999;135:689-97. https://doi.org/10.1016/S0022-3476(99)70086-7
Yadav SP, Kalra M, Anjan M, Sachdeva A. Survival outcome in childhood acute lymphoblastic leukemia in India. Pediatr Blood Cancer. 2010;54:178. https://doi.org/10.1002/pbc.22273 PMid:19731333
Mostert S, Sitaresmi MN, Gundy CM, Sutaryo, Veerman AJP. Influence of socioeconomic status on childhood acute lymphoblastic leukemia treatment in Indonesia. Pediatrics. 2006;118:e1600-6. https://doi.org/10.1542/peds.2005-3015 PMid:17074838
Petridou ET, Sergentanis TN, Perlepe C, Papathoma P, Tsilimidos G, Kontogeorgi E, et al. Socioeconomic disparities in survival from childhood leukemia in the United States and globally: a meta-analysis. Ann Oncol. 2015;26:589-97. https://doi.org/10.1093/annonc/mdu572 PMid:25527416
Hidayat R, Gatot D, Djer MM. Validasi sistem skoring rondinelli untuk mendeteksi komplikasi infeksi berat pada pasien leukemia limfoblastik akut l1 dengan demam neutropeni selama kemoterapi fase induction. Sari Pediatr. 2014;15:325–31. https://doi.org/10.14238/sp15.5.2014.325-31
Mihaela C, Despina B, Adrienne H, Moldovan D. Nutritional parameters in children with acute leukemia. J Am Diet Assoc. 2010;82:12-15.
Asim M, Zaidi A, Ghafoor T, Qureshi Y. Death analysis of childhood acute lymphoblastic leukaemia: experience at Shaukat Khanum memorial cancer hospital and research centre, Pakistan. J Pak Med Assoc. 2011; 61: 666–70. PMid:22204242
Widjajanto PH, Sutaryo S, Purwanto I, Ven PM, Veerman AJP. Early response to dexamethasone as prognostic factor: result from indonesian childhood wk-all protocol in Yogyakarta. J Oncol. 2012;2012:417941. https://doi.org/10.1155/2012/417941 PMid:22548058 PMCid:PMC3324166
Conner JM, Aviles-Robles MJ, Asdahi PH, Zhang FF, Ojha RP. Malnourishment and length of hospital stay among paediatric cancer patients with febrile neutropenia: a developing country perspective. BMJ Support Palliat Care. 2016;6:338-43. https://doi.org/10.1136/bmjspcare-2015-001020 PMid:27267224
Markus RE, Goldman JM. Management of infection on in the neutropenic patient. Br Med J. 1986;293:406-8. https://doi.org/10.1136/bmj.293.6544.406
Avilés-Robles M, Ojha RP, González M, Ojeda-Diezbarroso K, Dorantes-Acosta E, Jackson BE, et al. Bloodstream infections and inpatient length of stay among pediatric cancer patients with febrile neuropenia in Mexico City. Am J Infect Control. 2014;42:1235-7. https://doi.org/10.1016/j.ajic.2014.07.021 PMid:25234044
Sharma M. Nutrional management of cancer and bone marrow transplant in children. In: Sharma M, editor. Pediatric nutrition in health and disease. 1st Edition. New Delhi; Jaypee Brothers Medical Publishers (P) LTD: 2013.p. 308-17.
Kleinman RE, Greer FR. Nutritional management of children with cancer. In: Kleinman RE, Greer FR, editors. Pediatric nutrition. 7th Edition. American Academy of Pediatrics: 2014.p.1021-34.
Copyright (c) 2018 Marshalla Agnes, Pudjo Hagung Widjajanto, Wahyu Damayanti
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Accepted 2018-12-13
Published 2018-12-13
