The energy and
protein status of 12 adult patients with acute
leukemia (AL) was investigated during
induction chemotherapy.
Parenteral nutrition (PN) (nonprotein [NP], 31.4 kcal/kg/d;
nitrogen [N], 0.177 g/kg/d) was started on day 6 after the beginning of
chemotherapy and continued through all of the cytopenic phase. A clinical and metabolic evaluation, including measurement of resting energy expenditure (REE) by indirect calorimetry, was performed on each patient within the 2 days before beginning
chemotherapy (D0), on the third day of
chemotherapy (D3), and then weekly from day 7 until the end of the cytopenic phase. Measured REE at day 0 (29.5 +/- 1.4 kcal/kg/d) was significantly higher (+34 +/- 6%) than theoretical REE.
Chemotherapy induced a significant decrease in REE at day 3 (26.2 +/- 1.7 kcal/kg/d; P less than 0.05), but during the cytopenic phase REE was not different significantly from its initial values (D0). A positive energy balance was observed during the whole study after the beginning of PN. In contrast, mean
nitrogen balance remained negative always, due to a sharp increase in urinary
nitrogen loss during the cytopenic phase. The fact that
nutritional support falls short of its goal may explain why no improvement in
tumor response to
therapy has been described in most studies.