Computed tomography-derived sarcopenia, enteral nutritional support, and febrile neutropenia burden in children with acute lymphoblastic leukemia: a retrospective cohort study.

OBJECTIVE

This study aimed to evaluate computed tomography-derived sarcopenia and enteral nutritional support in relation to febrile neutropenia burden, hospital stay, and mortality in children receiving treatment for acute lymphoblastic leukemia.

MATERIALS AND

METHODS

This retrospective single-center cohort included 100 children aged 3-17 years with acute lymphoblastic leukemia treated between April 2020 and March 2024. Clinical data on febrile neutropenia episodes, neutropenia duration, severe neutropenia, hospital stay, enteral nutritional support, and febrile neutropenia-related mortality were collected from hospital records. Sarcopenia analysis was restricted to 50 patients with clinically indicated computed tomography images suitable for total psoas muscle area measurement. Total psoas muscle area was measured at the L4-L5 level. Sarcopenia was defined as a total psoas muscle area z-score < -2 according to age- and sex-specific reference values.

RESULTS

The median number of febrile neutropenia episodes was 6.5, ranging from 1 to 19. Febrile neutropenia-related mortality was observed in 17 patients. Forty-five patients received enteral nutritional support. Enteral nutritional support was associated with higher febrile neutropenia burden in unadjusted analysis; however, this was not interpreted as causal because enteral feeding may reflect underlying clinical severity. Among the 50 patients with total psoas muscle area data, 40 patients, corresponding to 80% of the imaged subgroup, were sarcopenic. Sarcopenia was not significantly associated with febrile neutropenia frequency, severe neutropenia, mortality, or hospital stay. In exploratory adjusted analysis, enteral nutritional support showed a borderline but non-significant association with febrile neutropenia frequency (IRR: 1.16, 95% CI: 1.00-1.36, p = 0.052).

CONCLUSION

Computed tomography-derived sarcopenia was common among imaged children with acute lymphoblastic leukemia but was not independently associated with febrile neutropenia burden or hospital stay. Enteral nutritional support should be interpreted as a marker of clinical vulnerability rather than a causal determinant of febrile neutropenia.