Abstract
Background: Pediatric acute lymphoblastic leukemia (ALL) outcomes in low- and middle-income nations remain compromised by treatment-related toxicities and infectious complications. Acute undernutrition is highly prevalent in these settings and may impair immune resilience during intensive therapy. This study evaluated the prevalence of baseline acute undernutrition in children with ALL and its association with severe infection rates during induction chemotherapy.
Methods: A retrospective study was conducted on 94 pediatric ALL patients (aged 1–15 years) who completed induction chemotherapy at Bangladesh Shishu Hospital, Dhaka, Bangladesh (2024–2025). Baseline nutritional status was classified using World Health Organization (WHO) anthropometric standards. Clinical parameters, severe infectious episodes, and demographic variables were recorded. Risk factors were evaluated using Chi-square/Fisher’s exact tests and Odds Ratios (OR) with 95% Confidence Intervals (CI).
Results: Out of 94 patients, 53.2% (n=50) presented with acute undernutrition at diagnosis. Undernourished children experienced nearly double the rate of severe infections during induction chemotherapy compared to normally nourished children (42% vs. 22.7%). In univariate analysis of undernourished patients, male gender (OR = 3.42, 95% CI: 1.08–10.86, p = .04) and baseline serum albumin 3.5 g/dL (OR = 5.29, 95% CI: 1.43–19.51, p = .01) were identified as statistically significant predictors of severe infectious complications. Conversely, no clinical or demographic parameters showed a statistically significant risk association in normally nourished patients.
Conclusion: Acute undernutrition is present in over half of pediatric ALL patients at diagnosis in Bangladesh and markedly elevates the risk of severe infections during induction chemotherapy, particularly among males and patients with hypoalbuminemia. Systemic nutritional screening and early nutritional supportive care should be incorporated into standard pediatric ALL management protocols.
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Copyright (c) 2026 Umme Nusrat Ara, Shabnam Shoyeb, Belayet Hossain, Abdul Wohab, Nilufar Akhtar Banu Choudhury, Sajeda Sultana, Hasan Mehdi, Fazlur Rahman Choudhury