title: Malnutrition in childhood lymphoblastic leukemia: a predictor of early mortality during the induction-to-remission phase of the treatment.
abstract: BACKGROUND
  Previous reports have shown that undernourished children with acute lymphoblastic leukemia (ALL) have a poorer long-term survival as compared with children with normal nourishment status. It has been shown that both the relapse and mortality rates of undernourished children with ALL are higher during the continuation phase of the chemotherapy and are apparently related to a poor tolerance of ablative chemotherapy. No previous articles have analyzed the early mortality rate of these patients.
  
  
  METHODS
  We carried out a case-control study, and have studied the effect of severe malnutrition on the mortality of 17 children with ALL during the initial induction-to-remission phase of the treatment. These 17 cases were compared with 76 controls who had survived at least the phases of induction and consolidation.
  
  
  RESULTS
  It was found that the chance of dying during the initial phase of the treatment was 2.6 times higher (confidence interval 95%: 0.55-11.89) in undernourished children with ALL than in those children with normal nourishment status. The risk of death increased with the severity of undernourishment (p = 0.04).
  
  
  CONCLUSIONS
  These data confirm the prognostic value of malnutrition in children with ALL and suggest that undernourishment may also influence early mortality during the induction-to-remission phase of the treatment.
authors.affiliation: Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, Instituto Mexicano del Seguro Social, D.F., México.
authors.forename: J M
authors.initials: JM
authors.lastname: Mejía-Aranguré
authors.forename: A
authors.initials: A
authors.lastname: Fajardo-Gutiérrez
authors.forename: N I
authors.initials: NI
authors.lastname: Reyes-Ruíz
authors.forename: R
authors.initials: R
authors.lastname: Bernáldez-Ríos
authors.forename: A M
authors.initials: AM
authors.lastname: Mejía-Domínguez
authors.forename: S
authors.initials: S
authors.lastname: Navarrete-Navarro
authors.forename: M C
authors.initials: MC
authors.lastname: Martínez-García
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D015362:Child Nutrition Disorders / Q000209:etiology*; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011379:Prognosis; D012074:Remission Induction