Objective:

To evaluate computed tomography-derived sarcopenia and enteral nutritional support in relation to febrile neutropenia burden, hospital stay, and mortality in children with acute lymphoblastic leukemia.

Key Findings:

• Median number of febrile neutropenia episodes was 6.5, with 17 patients experiencing febrile neutropenia-related mortality.
• 80% of the imaged patients were found to be sarcopenic.
• Sarcopenia was not significantly associated with febrile neutropenia frequency, severe neutropenia, mortality, or hospital stay.
• Enteral nutritional support was associated with higher febrile neutropenia burden but not interpreted as causal.

Interpretation:

Computed tomography-derived sarcopenia is prevalent among children with acute lymphoblastic leukemia but does not independently affect febrile neutropenia burden or hospital stay. Enteral nutritional support may indicate clinical vulnerability rather than being a direct cause of febrile neutropenia.

Limitations:

• Retrospective design may limit causal inferences.
• Nutritional assessment was not comprehensive for all patients.

Conclusion:

Sarcopenia is common in pediatric acute lymphoblastic leukemia patients, but its role in febrile neutropenia and hospital stay is not significant. Enteral nutritional support should be viewed as a marker of clinical severity.