Nutritional Recommendations for Children with Acute Lymphoblastic Leukemia

General Considerations

Children with Acute Lymphoblastic Leukemia (ALL) develop symptoms related to the infiltration of blasts in the bone marrow, lymphatic system, and extramedullary sites, which can include fatigue, constitutional symptoms (fever, night sweats, weight loss), shortness of breath, dizziness, infections, and a tendency to develop bruises or bleeding, according to the National Comprehensive Cancer Network 1, 2
Malnutrition is common in Asian children (17% in East Asia/Pacific and 46% in Southeast Asia are underweight) and can develop rapidly after anticancer treatment, as reported by The Lancet Oncology 3
Malnutrition can be associated with impaired immunity, decreased tolerance to chemotherapy, increased infection rates, and consequently, a poorer overall treatment outcome, as stated by The Lancet Oncology 3

Simple measures to prevent infections are a cost-effective strategy with significant benefits, according to The Lancet Oncology 3
Patients undergoing chemotherapy should be preferably admitted to a separate room from those with infectious diseases, and hand hygiene is especially important to prevent cross-infections, as recommended by The Lancet Oncology 3
Facilities for hand washing or hand disinfectant gels should be provided in the rooms, as suggested by The Lancet Oncology 3

Providing adequate hydration and allopurinol before starting steroids or other chemotherapy can help prevent tumor lysis syndrome, as recommended by The Lancet Oncology 3
Implementing protocols for febrile neutropenia based on local bacterial sensitivity can help prevent infections, according to The Lancet Oncology 3
Using a combination of trimethoprim and sulfamethoxazole can help prevent Pneumocystis jiroveci pneumonia, as recommended by The Lancet Oncology 3

Children with ALL who receive chemotherapy tend to suffer from intestinal parasitic diseases, requiring additional attention to food hygiene, as reported by The Lancet Oncology 3
In endemic areas, routine Mantoux testing and chest radiography are recommended for all newly diagnosed ALL patients, according to The Lancet Oncology 3