Nutritional assessment in patients undergoing intensive chemotherapy for acute myeloid leukemia

Fit patients (pts) with acute myeloid leukemia (AML) are conventionally administered repeated cycles of intensive chemotherapy (CHT), often followed by allogeneic hematopoietic stem cell transplant. Pts need to be hospitalized in a protected setting, they are often prescribed a neutropenic diet and chemotherapy-induced gastro-intestinal toxicity is common. As a result, nutritional imbalance is frequently observed. Aim of this study was to systematically assess the nutritional status of pts undergoing treatment for AML and to explore early predictors and associations with known nutritional risk scores and relevant clinical outcomes. Monitoring included a bioelectrical impedance analysis (BIA) performed by a dietitian to assess fat mass (FM), fat-free mass (FFM), body cell mass (BCM) and the phase angle (PhA) together with standard measures (body weight, BW; body mass index, BMI). Variations in nutritional parameters between admission and day 7 (end of CHT, dif7) or between admission and day 14 (dif14) were calculated and tested for correlation with variations of the same parameter at discharge from the same cycle (dif30) or at discharge after the first consolidation (dif60). From March 2021 to March 2023, 26 pts with newly diagnosed AML (median age 55y, range 21-74) were monitored during a total of 61 cycles of intensive CHT (35 induction cycles, 26 consolidation cycles). Median Nutritional Risk Score 2002 (NRS) at enrolment was 3 (range 2-6). Median follow up for surviving pts is 300 days. We observed a significant reduction in FFM and BCM during induction cycles. These trends were observed irrespectively of baseline NRS, disease response, or fever lasting more or less than 7 days. NRS was not significantly associated with any nutritional parameter variation. For FFM, BCM and PhA (but not BW or BMI), dif7 correlated with dif30 for induction and consolidation CHT. For BCM and PhA, both dif7 and dif14 also correlated with dif60. Variations in BCM (but not in BW) at day 7 correlated with weight loss at discharge after a second CHT cycle. Reduction in BW, BMI and FM at day 7, and of PhA at day 14 were associated with extended length of stay for consolidation CHT cycles only. No associations were found between nutritional status at admission or its variation and disease response to therapy. Preliminary results from this study show that BIA could reveal a nutritional deterioration as early as 7 days from admission, before BW changes become informative, and could trigger earlier and more effective support measures.