Walking inability in children during early treatment of acute lymphoblastic leukaemia: incidence and risk factors

Purpose: Acute lymphoblastic leukaemia (ALL) and its treatment cause side effects in paediatric patients which increase the risk of walking inability, limiting functional independence and quality of life. However, the incidence of walking inability, the time until onset and potential risk factors are unknown. Methods: We retrospectively retrieved data in ALL patients (≤ 18 years). Walking inability was defined as the incompetence to walk independently from diagnosis until the end of early treatment. A Kaplan–Meier analysis was conducted to estimate the time until walking inability. To assess the effect of risk factors, we estimated a Cox regression model and performed a landmark analysis. Results: In total, 226 patients (age median, 5.5 years; interquartile range, 3.4–11.7) were included. Walking inability was experienced by 15.0% at diagnosis and 28.3% during induction/consolidation1. Age at diagnosis (hazard ratio (HR) 0.901; 95% confidence interval (CI) 0.847–0.959) was a risk factor during induction/consolidation1. The landmark analysis at end of induction identified age at diagnosis (HR 0.898; 95% CI 0.830–0.971), delta weight-to-height Z-score (HR 0.577; 95% CI 0.410–0.812) and duration of hospitalizations (HR 1.076; 95% CI 1.005–1.152) as risk factors during consolidation1. Conclusion: Fifteen percent experienced walking inability at diagnosis and 28.3% temporarily stopped walking during early treatment. This is concerning because walking inability leads to isolation and loss of independence. Patients with younger age, decreasing weight and longer hospitalizations during the first month of treatment were at highest risk. Informing patients and parents about the occurrence of walking inability and studies on physiotherapy and nutritional interventions are indicated.