There is a dramatic improvement in the 5-year
survival rate for Acute Lymphoblastic Leukemia (ALL) in children, which
is now more than 80% in developed countries. Similar outcomes have also
been achieved in India, but only in few tertiary care centers. A lack of
accurate country-wide epidemiological data makes the exact rate unknown
[1,2]. As per the population-based cancer registry (PBCR) of Bengaluru
and Chennai, the cure rate for leukemia is much lower in India. This can
be due to multiple factors like limited access to adequate treatment,
limited resources, delay in diagnosis, infections and underlying
malnutrition. Deaths during initial phase of treatment is a major
concern, and is one of the main obstacles to improve survival rates in
children with ALL in developing countries. Most of these deaths are
attributed to the infections and poor tolerance to the treatment. A much
higher proportion of children in developing countries have malnutrition
at the time of diagnosis of cancers than those from developing countries
. Moreover, the proportion of high-risk patients with advanced
disease is more as compared to low-risk patients. Advanced cancer state
leads to altered nutritional state with protein and micronutrient
deficiency. The importance of nutrition in children with cancer is still
an underestimated topic within pediatric oncology. It is recognized that
diminished nutritional status may be a contributing factor for poor
immune function, disturbed drug metabolism leading to drug toxicities,
and adverse clinical outcome [4,5]. Altered nutritional and inflammatory
status has been shown to correlate with increased risk of severe
hematological toxicity following anticancer therapy .
Many studies from developed countries have evaluated
the impact of malnutrition on prognosis and survival of children with
ALL, and it is believed that malnutrition is a major factor in the
survival of such patients. However, it is necessary to know whether same
association also exists in developing countries, where the prevalence of
malnutrition is high and deaths during initial phase of treatment is
higher . Orgel, et al. , in a cohort of 2008 children with
high risk ALL, reported that extremes of weight (obesity and
undernutrition) at diagnosis resulted in inferior event-free survival.
An earlier study from India  showed a higher incidence of febrile
neutropenia in undernourished children with ALL, and also reported an
association of undernutrition and poor outcome.
In the current issue of Indian Pediatrics,
Tandon, et al.  have reinforced the importance of identifying
altered nutritional status in children with ALL. This study has shown an
association of hypoalbuminemia, folate and vitamin B
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