Sarcopenia in children with acute leukemia worsened after induction therapy

Sarcopenia is a prevalent condition among elderly individuals and is characterized by the loss of skeletal muscle mass accompanied by physical dysfunction. In older adults, decreased insulin-like growth factor 1 (IGF-1) has been implicated as a contributing factor to the development of sarcopenia. Children with chronic conditions associated with sarcopenia are rarely evaluated. This study aimed to evaluate muscle mass using cross-sectional computed tomography (CT) images in pediatric patients with acute leukemia and patients without chronic diseases, and to examine the relationship between skeletal muscle mass volume and various growth parameters in children with acute leukemia. The study included 44 pediatric patients (age: 1-15 years) with newly diagnosed acute leukemia (B-cell lymphoblastic leukemia, n = 30; T-cell lymphoblastic leukemia, n = 5; other types, n = 9) who underwent abdominal CT before treatment initiation. Among these, 15 underwent abdominal CT after induction therapy. The total psoas muscle area at lumbar vertebrae levels 3-4, body height, weight, and IGF-1 levels were retrospectively analyzed. The total psoas muscle area significantly decreased after induction therapy in all 15 patients. A significant correlation was observed between the rate of change in total psoas muscle area and IGF-1 levels (n = 9; p < 0.05; r = -0.84). However, no correlation was identified between the rate of change in total psoas muscle area and height velocity before and after treatment. In conclusion, skeletal muscle mass decreased following treatment initiation in pediatric patients with acute leukemia. The degree of muscle mass loss was more severe in patients with higher pre-treatment IGF-1 levels.