Nutritional status and socio-economic conditions as prognostic factors in the outcome of therapy in childhood acute lymphoblastic leukemia

The majority of children on earth are to be found in the developing world, many of them malnourished members of impoverished families. Thus, the effec ts of socio-economic status (SES) on the therapeutic response of children w ith cancer are obviously relevant. The outcome of treatment in patients wit h the commonest form of cancer in childhood (acute lymphoblastic leukemia, ALL) is clearly related to their SES, Studies conducted mainly in developin g countries have shown malnutrition to be an important prognostic factor in such children. However, other socio-economic conditions could affect the o utcome of therapy in patients with ALL: access to communications, transport ation, laboratory studies and therapy, Even in children with an "adequate" SES, malnutrition is still an adverse prognostic factor, Nutritional supple mentation appears to be a valuable addition to chemotherapy in undernourish ed children with ALL, The choice of treatment for these children should acc omodate the cultural, economic and nutritional status of the patients and t heir families. Protocols must be created for testing methods of nutritional intervention and their influence on pharmacology, drug tolerance and survi val in ALL. The influences of poverty and illiteracy on compliance with tre atment, especially oral medication, need to be evaluated. Such investigatio ns are essential to improve results of treatment of socio-economically disa dvantaged children suffering from ALL and other forms of cancer. (C) 1998 W iley-Liss, Inc.