LEUKEMIA AND NUTRITION .4. IMPROVEMENT IN THE NUTRITIONAL-STATUS OF CHILDREN WITH STANDARD-RISK ACUTE LYMPHOBLASTIC-LEUKEMIA IS ASSOCIATED WITH BETTER TOLERANCE OF CONTINUATION CHEMOTHERAPY

Purpose: We have shown previously that malnutrition is an adverse prog nostic factor in the outcome of treatment of children with standard-ri sk acute lymphoblastic leukemia. Due to a diminished bone marrow reser ve, undernourished children poorly tolerate ''maintenance'' chemothera py with 6-mercaptopurine and methotrexate; as a result, they relapse m ore frequently than well-nourished children with ALL who receive full doses of chemotherapy. The purpose of this study was to assess the imp ortance of an oral supplemental feeding program in children with stand ard-risk acute lymphoblastic leukemia in complete remission. Patients and Methods: A group of 31 patients was given, together with ''mainten ance'' chemotherapy, a daily snack-bar containing 200 calories, 11 gra ms of protein, 8 grams of fat, 21 grams of carbohydrates and several v itamins. Results: After a 3-month period of dietary supplementation, w e found that, in addition to increases in weight, height, levels of he moglobin, serum albumin, and body fat deposition, there was a better t olerance of the ''maintenance'' chemotherapy. A longer follow-up of th ese patients is needed to determine if such nutritional support progra ms are associated with a better prognosis, specifically longer disease -free survival.