The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review

Associations of Ferritin and Folate Status With Clinical Outcomes in Childhood Cancer Patients: A Prospective Cohort Study

BACKGROUND

Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications.

METHODS

This prospective cohort study enrolled children <18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event-free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes.

RESULTS

Eighty-two patients (median [interquartile range] 3.9 (1.9-8.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios = 0.161, 95% CI = 1.000-1.002, p = 0.032). Higher ferritin was associated with increased number of treatment-related complications (B = 7.3E-5, 95% CI = 1.5E-5-0.000, p = 0.013). Folate status showed significant association with body mass index category (χ2 = 9.564, p = 0.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate (F(2.9); p = 0.06; -2LL (1381)). Haematological malignancies (F(2.8); p = 0.05; -2LL (4244)) and medium and high treatment intensity (F(2.4); p = 0.09; -2LL 4262)) were associated with higher ferritin levels over 18 months.

CONCLUSIONS

Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large-scale population-based studies and clinical trials are now warranted.

piRNAs in leukemogenesis: Mechanisms, biomarkers, and therapeutic implications

The small, non-coding RNAs known as piwi-interacting RNAs (piRNAs) serve essential roles in gene regulation by silencing transposable elements and protecting oncogenes and tumour suppressors. The production of piRNA bioactive forms uses precursor mRNAs, which team with Piwi proteins to support genome maintenance. Accurate leukaemia regulation requires piRNAs because abnormalities in these regulatory elements contribute to disease development and drug resistance progression. Their utility in disease detection appears promising through their distinct pattern expression across different leukaemia subtypes. These piRNA markers promise to enhance early detection of diseases and provide treatment effectiveness and outcome information. Lesions examined by microarrays qRT-PCR and high-throughput sequencing provide professionals with essential tools for studying piRNA profiles and tracking their activities in leukaemia treatment. PiRNAs establish interactions with microRNAs and long non-coding RNAs through complex regulatory networks, contributing to leukaemia development. The therapeutic applications of piRNAs in leukaemia treatment have proven promising, yet additional research is necessary to understand their specific functions and improve standardized detection capability. The field requires future investigations dedicated to designing piRNA-based diagnostic instruments, researching piRNA-derived drug resistance prevention strategies, and optimizing individualized treatment plans for leukaemia patients.

Impact of Acute Lymphoblastic Leukaemia Treatment on the Nutritional Status of Paediatric Patients: A Systematic Review

INTRODUCTION

Acute lymphoblastic leukaemia (ALL) is the most prevalent cancer in childhood and is one of the leading causes of death annually. Antineoplastic treatments are associated with a high risk of malnutrition, which is important for continuous growth and development.

OBJECTIVE

This systematic review aimed to evaluate the effect of these treatments on the nutritional status of paediatric patients with ALL. Data were collected from the PubMed, Scopus, and Web of Science databases following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. All the studies in which nutritional status was assessed in human beings diagnosed with ALL up to 18 years and published in English or Spanish between January 1900 and December 2023 were included.

RESULTS

A total of 18 articles and 1692 participants were analysed in this review. Article quality was evaluated using the ROBINS-I tool. This systematic review has been registered on PROSPERO (CRD42024505111). ALL treatment has a negative impact on the nutritional status of these patients and played an important role in their growth and global development. ALL treatments can modify hunger perception and the palatability of food.

CONCLUSIONS

Nutritional status is important for patient prognosis and survival. Nutritional evaluation, a specific nutritional assessment, and follow-up should be recommended for these patients to decrease the nutritional impact on global health. More homogeneous studies must be conducted to reach robust conclusions regarding the best type of nutritional intervention for these patients.

Caregiver perceptions of child heath behaviors and weight during treatment for acute lymphoblastic leukemia

BACKGROUND

Changes in health behaviors and weight are common during the early phases of pediatric acute lymphoblastic leukemia treatment, and may negatively impact treatment tolerability. Given that ALL is most prevalent in children, caregivers play an essential role in shaping health behaviors during treatment. This study presents a qualitative analysis of semi-structured interviews with caregivers of youth in the early phases of ALL treatment.

PROCEDURE

Caregivers (N = 17, 95% female) of a child (M age = 6.76 years) diagnosed with ALL and on treatment for less than 1 year (M = 8.7 months since diagnosis) completed a semi-structured interview about perceptions of their child's nutrition, physical activity, sedentary time, and weight during ALL treatment. Thematic analysis followed Braun and Clark's six-step framework (2006). Two coders established reliability (alpha = .88) and used a multi-pass coding system to extract themes.

RESULTS

Caregivers' concerns around their child's weight during ALL treatment primarily centered around avoiding malnutrition. Weight gain during treatment was less of a concern and often viewed as protective. Caregivers reported encouraging their child to eat palatable, calorie-dense foods to mitigate risk for weight loss. Caregivers also expressed concern that children were less active and more sedentary due to treatment-related pain. Caregivers discussed health behaviors during treatment as being child-directed, rather than parent- or provider-directed.

CONCLUSION

Future interventions may consider strategies to engage in joint parent-child decisions and caregiver education around risks of excessive weight gain during treatment. Interventions should include anticipatory guidance and aim to support parents in developing skills to support their child's health behaviors during treatment.

The Role of Diet in the Cardiovascular Health of Childhood Cancer Survivors-A Systematic Review

BACKGROUND

Childhood cancer survivors (CCSs) face an increased risk of cardiovascular disease (CVD). This systematic review aims to provide the first synthesis of observational and interventional studies on the relationship between diet and cardiovascular health in CCSs.

METHODS

A comprehensive search was conducted for studies published between 1990 and July 2023 in PubMed, MEDLINE, CINAHL, Child Development & Adolescent Studies, and Cochrane Library. Eligible studies included observational and interventional studies examining the associations or effects of dietary factors on CVD incidence, cardiac dysfunction, or CVD risk factors in CCSs diagnosed before age 25 years.

RESULTS

Ten studies met the inclusion criteria (nine observational and one interventional). Collectively, they comprised 3485 CCSs (male, 1734; female, 1751). The outcomes examined across observational studies included characteristics of obesity, diabetes biomarkers, hypertension indicators, dyslipidaemia biomarkers, and metabolic syndrome. The evidence suggested that greater adherence to healthy diets was associated with lower body mass index, blood pressure, glucose, and triglycerides and higher high-density lipoprotein cholesterol. The 12-week lifestyle intervention study in childhood leukaemia survivors found no impact on obesity indicators.

CONCLUSION

The review results indicate the potentially protective effects of healthy diets. However, the available research remains preliminary and limited, underscoring the need for more rigorous, adequately powered studies.