Longitudinal changes in nutritional status during induction chemotherapy and their association with treatment outcomes in pediatric patients with newly diagnosed acute myeloid leukemia.
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OBJECTIVES: This study retrospectively analyzed longitudinal changes in key nutritional indicators-weight Z-score, BMI Z-score, and serum albumin-in children with newly diagnosed acute myeloid leukemia (AML) from the start of induction chemotherapy through 30 days post-treatment. We examined how the magnitude of decline and rate of recovery of these indicators correlated with induction remission rates, treatment-related mortality (TRM), and complication rates, with particular focus on the predictive value of weight Z-score decline for subsequent toxicities (gastrointestinal, hepatic, infectious) and remission-phase mortality. We also tested the hypothesis that greater nutritional deterioration is associated with poorer treatment outcomes, addressing limitations of conventional static assessments and informing optimal timing for early nutritional intervention. MATERIALS AND METHODS: This retrospective cohort study was conducted on pediatric patients with newly diagnosed AML from January 2015 to December 2024. Nutritional indicators were dynamically monitored at four time points: pre-induction (T0), chemotherapy completion (T1), 15 days post-completion (T2), and 30 days post-completion (T3). The decline magnitude (T0-T2) and recovery rate (T2-T3) of each indicator were calculated. Patients were stratified into three groups based on weight Z-score decline magnitude: mild decline (<0.5), moderate decline (0.5-1.0), and severe decline (>1.0). Induction remission, TRM, complications, and treatment toxicity were compared across the three groups. Multivariate logistic regression analysis was performed to identify the associations between nutritional indicator changes and induction treatment outcomes. Receiver operating characteristic (ROC) curves were evaluated the predictive performance of weight Z-score decline for treatment toxicities and remission-phase mortality. RESULTS: Clinical data of a total of 62 pediatric patients (34 males, 28 females; mean age 7.3 ± 3.6 years) were analyzed. Longitudinal monitoring revealed a consistent decline - then - recovery trend for weight Z-score, BMI Z-score, and serum albumin: all indicators decreased continuously from T0 to T2, followed by gradual recovery from T2 to T3. Weight Z-score and BMI Z-score reached their nadirs at T2, while serum albumin bottomed out at T1. Patients with severe weight Z-score decline showed significantly lower remission rates (56.3% vs. 88.5% in mild and 75.0% in moderate groups) and higher TRM (18.8%) and complication rates (87.5%). They also experienced more frequent gastrointestinal, hepatic, and infectious toxicities, and higher remission-phase mortality (12.5% vs. 0.0 and 5.0%). Multivariate analysis identified weight Z-score decline > 1.0 (OR = 4.826, 95%CI: 2.673-8.725) and serum albumin decline > 10 g/L (OR = 3.715, 95%CI: 2.012-6.857) as independent risk factors for poor outcomes. ROC analysis confirmed strong predictive value of weight Z-score decline for gastrointestinal toxicity (AUC = 0.823), hepatic toxicity (AUC = 0.812), infectious toxicity (AUC = 0.854), and remission-phase mortality (AUC = 0.881). CONCLUSION: The nutritional status of pediatric patients with newly diagnosed AML follows a distinct decline-then-recovery longitudinal pattern during induction chemotherapy. Greater decline and slower recovery are significantly associated with worse treatment outcomes. Weight Z-score decline serves as a robust predictor of subsequent toxicities and mortality, supporting its use alongside traditional static assessments. These findings provide an evidence-based rationale for initiating nutritional support by the time chemotherapy ends.