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NUTRITIONAL STATUS

AMONG ACUTE
LYMPHOBLASTIC LEUKEMIA
(ALL) SURVIVORS
Stefanus Gunawan 1 , Eka Satria Anandita 2 , Permatami

IN INDONESIA Herwansyah 3 , Max Mantik 4


1
Acute Leukemia in 30 40 % of malignancy
children
4 4,4 case annually /
100,000 children below 15
y.o
Acute leukemia percentage is
up to 97% of all leukemia in
children
82%:
ALL
18%:
AML
2
Dr. Sardjito Hospital Dr. Soetomo Hospital
(Yogyakarta, Indonesia) (Surabaya, Indonesia)
1996 2002

5-6 new cases / 79 new cases


month during this year

ALL: 79% ALL: 88%


AML: 9% AML: 8%
Chronic leukemia: Chronic leukemia:
12% 4%
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Nutritional status
among ALL
survivors
Lorenzo Lughetti, Patrizia Bruzzi, Barbara Predieri,
Paolo Paolucci
75% of survivors have a chronic health condition
negatively impacting on cardiovascular morbidity
and mortality, Obesity can be considered one of
the most important health chronic conditions in
the general population, with an increasing
incidence in patients treated for childhood
cancers and especially in acute lymphoblastic
leukemia survivors who are, at the same time,
more at risk of experiencing precocious
cardiovascular and metabolic co-morbidities.

Ital J. Pediatr. 2012; 38: 4.

Obesity
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Nutritional status
among ALL
survivors
Kirsten K. Ness, Saro H. Armenian, Nina Kadan-Lottick,
James G. Gurney
Childhood ALL survivors experience medical late
effects that increase their risk of morbidity and
premature death, often due to heart and vascular
disease. Research has helped elucidate the
mechanisms and trajectory of direct damage to
the heart from treatment exposure, particularly to
anthracyclines, and has also contributed
knowledge on the influences of related chronic
conditions, such as obesity and insulin resistance
on heart health in these survivors.

Expert Rev Hematol. 2011 Apr; 4(2): 185197.

Obesity
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Nutritional status
among ALL
survivors
Susan J. Lindemulder, Linda C. Stork, Bruce
Bostrom et al

Our study of patients with SR-ALL found a


significant increase in BMI% largely during the
first month of therapy that is greater with
dexamethasone than prednisone. However, after
therapy, there was no increased risk of
overweight/obese BMI compared to non-cancer
peers.

Pediatr Blood Cancer. 2015 Jun; 62(6): 10351041.

Obesity
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Cross Sectional
study
45 ALL 9 persons cannot be
survivors contacted
36 persons consented for
examination

National Cancer Institute


(NCI)

High Risk (HR) ALL : 14


persons
Standart Risk (SR) ALL : 22
persons
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ALL survivors weight and
height

WHO weight-for-height
curve
CDC stature-for-age and weight-for-
age curve

CDC body mass index curve

Nutritional status
8

HR ALL

14% 7%

14%

65%

Undernourished (1 person) Good nutritional status (9 persons)


Overnourished (2 persons) Obesity (2 persons)
9
ALL Standart Risk

5%
23%

9%
63%

Undernourished (1 person) Good nutritional status (14 person)


Overnourished (2 persons) Obesity (5 persons)
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Summary of ALL survivors nutritional status

6%
19%

11%

64%

Undernourished (2 persons) Good nutritional status (23 persons)


Overnourished (4 persons) Obesity (7 persons)
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ALL * Nutritional Status Crosstabulation
Nutritional status
Good
nutritional Underno Overno
status urished urished Obesity Total
ALL HR ALL Count 10 1 3 2 16
% within ALL 62.5% 6.3% 18.8% 12.5% 100.0%
% within
Nutritional 45.5% 50.0% 75.0% 28.6% 45.7%
Status
SR ALL Count 12 1 1 5 19
% within ALL 63.2% 5.3% 5.3% 26.3% 100.0%
% within
Nutritional 54.5% 50.0% 25.0% 71.4% 54.3%
status
Total Count 22 2 4 7 35
% within ALL 62.9% 5.7% 11.4% 20.0% 100.0%
% within
Nutritional 100.0% 100.0% 100.0% 100.0% 100.0%
status
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Chi-Square Tests
Asymp. Sig. (1-
Value df sided)
Pearson Chi-Square 2.227a 3 .263

N of Valid Cases 35
a. 6 cells (75.0%) have expected count less than 5. The minimum expected
count is .91.

The relationship between ALL and nutritional status was tested by X 2 test.
The test results X2 = 2.227, p = 0.263.

These results suggest there is no difference in the distribution of


nutritional status between HR ALL and SR ALL.
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CONCLUSION

Majority of the ALL survivors in Manado, Indonesia have


good nutritional status. Obesity and overnutrition are not
an issue in both SR and HR ALL survivors receiving
chemotherapy in Manado, Indonesia.

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