Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1994 Oct;71(4):304–310. doi: 10.1136/adc.71.4.304

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

M B Viana 1, M Murao 1, G Ramos 1, H M Oliveira 1, R I de Carvalho 1, M de Bastos 1, E A Colosimo 1, W S Silvestrini 1
PMCID: PMC1030006  PMID: 7979521

Abstract

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.

Full text

PDF
304

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aur R. J., Hanna M., Sabbah R., Sackey K., Willoughby S., Atwood J. Effective prevention of central nervous system leukemia with intrathecal methotrexate and intrathecal methotrexate, cytosine arabinoside, and hydrocortisone in childhood acute lymphocytic leukemia. Haematol Blood Transfus. 1990;33:504–510. doi: 10.1007/978-3-642-74643-7_91. [DOI] [PubMed] [Google Scholar]
  2. Campos-Filho N., Franco E. L. Microcomputer-assisted multivariate survival data analysis using Cox's proportional hazards regression model. Comput Methods Programs Biomed. 1990 Feb;31(2):81–87. doi: 10.1016/0169-2607(90)90054-d. [DOI] [PubMed] [Google Scholar]
  3. Campos-Filho N., Franco E. L. Microcomputer-assisted univariate survival data analysis using Kaplan-Meier life table estimators. Comput Methods Programs Biomed. 1988 Nov-Dec;27(3):223–228. doi: 10.1016/0169-2607(88)90086-7. [DOI] [PubMed] [Google Scholar]
  4. Davies H. A., Lennard L., Lilleyman J. S. Variable mercaptopurine metabolism in children with leukaemia: a problem of non-compliance? BMJ. 1993 May 8;306(6887):1239–1240. doi: 10.1136/bmj.306.6887.1239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Eden O. B., Lilleyman J. S., Richards S., Shaw M. P., Peto J. Results of Medical Research Council Childhood Leukaemia Trial UKALL VIII (report to the Medical Research Council on behalf of the Working Party on Leukaemia in Childhood). Br J Haematol. 1991 Jun;78(2):187–196. doi: 10.1111/j.1365-2141.1991.tb04415.x. [DOI] [PubMed] [Google Scholar]
  6. Freeman A. I., Weinberg V., Brecher M. L., Jones B., Glicksman A. S., Sinks L. F., Weil M., Pleuss H., Hananian J., Burgert E. O., Jr Comparison of intermediate-dose methotrexate with cranial irradiation for the post-induction treatment of acute lymphocytic leukemia in children. N Engl J Med. 1983 Mar 3;308(9):477–484. doi: 10.1056/NEJM198303033080902. [DOI] [PubMed] [Google Scholar]
  7. Hamill P. V., Drizd T. A., Johnson C. L., Reed R. B., Roche A. F., Moore W. M. Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr. 1979 Mar;32(3):607–629. doi: 10.1093/ajcn/32.3.607. [DOI] [PubMed] [Google Scholar]
  8. Hicsönmez G., Ozsoylu S., Yetgin S., Zamani V., Gurgey A. Poor prognosis of childhood acute lymphoblastic leukaemia. Br Med J (Clin Res Ed) 1983 Apr 30;286(6375):1437–1437. doi: 10.1136/bmj.286.6375.1437-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Kalwinsky D. K., Rivera G., Dahl G. V., Roberson P., George S., Murphy S. B., Simone J. V. Variation by race in presenting clinical and biologic features of childhood acute lymphoblastic leukaemia: implications for treatment outcome. Leuk Res. 1985;9(6):817–823. doi: 10.1016/0145-2126(85)90300-5. [DOI] [PubMed] [Google Scholar]
  10. Koren G., Ferrazini G., Sulh H., Langevin A. M., Kapelushnik J., Klein J., Giesbrecht E., Soldin S., Greenberg M. Systemic exposure to mercaptopurine as a prognostic factor in acute lymphocytic leukemia in children. N Engl J Med. 1990 Jul 5;323(1):17–21. doi: 10.1056/NEJM199007053230104. [DOI] [PubMed] [Google Scholar]
  11. Lobato-Mendizábal E., Ruiz-Argüelles G. J., Marín-López A. Leukaemia and nutrition. I: Malnutrition is an adverse prognostic factor in the outcome of treatment of patients with standard-risk acute lymphoblastic leukaemia. Leuk Res. 1989;13(10):899–906. doi: 10.1016/0145-2126(89)90043-x. [DOI] [PubMed] [Google Scholar]
  12. McWhirter W. R., Smith H., McWhirter K. M. Social class as a prognostic variable in acute lymphoblastic leukaemia. Med J Aust. 1983 Oct 1;2(7):319–321. doi: 10.5694/j.1326-5377.1983.tb122488.x. [DOI] [PubMed] [Google Scholar]
  13. Miller D. R., Krailo M., Bleyer W. A., Lukens J. N., Siegel S. E., Coccia P. R., Weiner J., Hammond D. Prognostic implications of blast cell morphology in childhood acute lymphoblastic leukemia: a report from the Childrens Cancer Study Group. Cancer Treat Rep. 1985 Oct;69(10):1211–1221. [PubMed] [Google Scholar]
  14. Miller D. R., Miller L. P. Acute lymphoblastic leukemia in children: an update of clinical, biological, and therapeutic aspects. Crit Rev Oncol Hematol. 1990;10(2):131–164. doi: 10.1016/1040-8428(90)90004-c. [DOI] [PubMed] [Google Scholar]
  15. Mora J. O. A new method for estimating a standardized prevalence of child malnutrition from anthropometric indicators. Bull World Health Organ. 1989;67(2):133–142. [PMC free article] [PubMed] [Google Scholar]
  16. Niemeyer C. M., Reiter A., Riehm H., Donnelly M., Gelber R. D., Sallan S. E. Comparative results of two intensive treatment programs for childhood acute lymphoblastic leukemia: The Berlin-Frankfurt-Münster and Dana-Farber Cancer Institute protocols. Ann Oncol. 1991 Nov-Dec;2(10):745–749. doi: 10.1093/oxfordjournals.annonc.a057856. [DOI] [PubMed] [Google Scholar]
  17. Oakhill A., Mann J. R. Poor prognosis of acute lymphoblastic leukaemia in Asian children living in the United Kingdom. Br Med J (Clin Res Ed) 1983 Mar 12;286(6368):839–841. doi: 10.1136/bmj.286.6368.839. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Palmer M. K., Hann I. M., Jones P. M., Evans D. I. A score at diagnosis for predicting length of remission in childhood acute lymphoblastic leukaemia. Br J Cancer. 1980 Dec;42(6):841–849. doi: 10.1038/bjc.1980.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Pavlovsky S., Sackmann Muriel F., Santarelli M. T., Svarch E., Jiménez E., Kohan R., Rosso A. An update of the results of intensive therapy in children with acute lymphoblastic leukemia. Leukemia. 1992;6 (Suppl 2):167–170. [PubMed] [Google Scholar]
  20. Peeters M., Koren G., Jakubovicz D., Zipursky A. Physician compliance and relapse rates of acute lymphoblastic leukemia in children. Clin Pharmacol Ther. 1988 Mar;43(3):228–232. doi: 10.1038/clpt.1988.25. [DOI] [PubMed] [Google Scholar]
  21. Pendergrass T. W., Hoover R., Godwin JD I. I. Prognosis of black children with acute lymphocytic leukemia. Med Pediatr Oncol. 1975;1(2):143–148. doi: 10.1002/mpo.2950010209. [DOI] [PubMed] [Google Scholar]
  22. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Riehm H., Gadner H., Henze G., Kornhuber B., Lampert F., Niethammer D., Reiter A., Schellong G. Results and significance of six randomized trials in four consecutive ALL-BFM studies. Haematol Blood Transfus. 1990;33:439–450. doi: 10.1007/978-3-642-74643-7_81. [DOI] [PubMed] [Google Scholar]
  24. Rivera G. K., Pui C. H., Hancock M. L., Mahmoud H., Santana V., Sandlund J. T., Hurwitz C., Ribeiro R., Furman W., Crist W. M. Update of St Jude Study XI for childhood acute lymphoblastic leukemia. Leukemia. 1992;6 (Suppl 2):153–156. [PubMed] [Google Scholar]
  25. Schrappe M., Beck J., Brandeis W. E., Feickert H. J., Gadner H., Graf N., Havers W., Henze G., Jobke A., Kornhuber B. Die Behandlung der akuten lymphoblastischen Leukämie im Kindes- und Jugendalter: Ergebnisse der multizentrischen Therapiestudie ALL-BFM 81. Klin Padiatr. 1987 May-Jun;199(3):133–150. doi: 10.1055/s-2008-1026780. [DOI] [PubMed] [Google Scholar]
  26. Szklo M., Gordis L., Tonascia J., Kaplan E. The changing survivorship of white and black children with leukemia. Cancer. 1978 Jul;42(1):59–66. doi: 10.1002/1097-0142(197807)42:1<59::aid-cncr2820420109>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES