Avaliação da composição corporal e do estado nutricional antes e após o tratamento quimioterápico e sua associação com a toxicidade em pacientes pediátricos com linfoma: um estudo retrospectivo

Abstract

Hematological malignancies are prevalent in the pediatric population. In the pediatric age group, lymphomas account for 14% of all cancers. The nutritional status, based on weight and height, as well as the body surface used to calculate chemotherapy, do not reflect the body composition of individuals, leading to changes in the distribution of the drug and, consequently, greater toxicities. Thus, this study aims to evaluate body composition and nutritional status before and after treatment of children and adolescents with lymphoma and their association with the toxicity of chemotherapy treatment. A retrospective cohort was carried out with patients aged 6 to 18 years, diagnosed with lymphoma. Data relating to disease, treatment, nutritional status and toxicities were taken from medical records. Computed tomography (CT) scans before and after chemotherapy were evaluated for body composition parameters (skeletal muscle area, subcutaneous, visceral and intramuscular adipose tissue, and muscle radiodensity). The correlation of body composition parameters with nutritional status parameters was statistically evaluated, body composition values before and after chemotherapy were compared, and associations were made between such parameters and hematological toxicities (anemia, leukopenia, lymphocytopenia, thrombocytopenia and febrile neutropenia) and non-hematological (diarrhea, nausea, emesis, constipation, mucositis, respiratory and non-respiratory infections and fever). 52 patients with a mean age of 13.20 years were included in the study, 50.00% of each sex. It was observed that the majority of patients started treatment with a body mass index (BMI) classification of eutrophy (53.80%) and without sarcopenia (82.50%), and that they showed an increase in all composition parameters. body, except for muscle radiodensity (HU), which was significantly reduced (40.71HU to 35.43HU, p-value < 0.001), showing a reduction in muscle quality during chemotherapy. A correlation was found between BMI and muscle and body fat at the same time (0.718; p-value < 0.001 and 0.912; p-value < 0.001, respectively). Furthermore, most patients with subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) above the median had thrombocytopenia (p-value = 0.027), and the majority of patients who did not present febrile neutropenia had BAC below the median. (p-value = 0.037) and HU above the median (p-value = 0.047). HU before treatment was also associated with mucositis (p-value = 0.002) and non-respiratory infections (p-value = 0.011). The measurement of HU after chemotherapy was able to explain the changes in the absolute values of hematological parameters (hemoglobin, p-value = 0.004; platelets, p-value = 0.003; neutrophils, p-value = 0.032; leukocytes, p-value = 0.029), except for lymphocytes, regardless of sex and age group. Some body composition parameters, mainly muscle quality, have been associated with the appearance of toxicities during chemotherapy. Furthermore, the worsening of muscle quality was sufficient to explain reductions in hematological parameters.