Calorie restriction via diet and exercise may improve response to chemotherapy among some younger patients with hematologic malignancies. These findings, from a prospective, nonrandomized, controlled trial, were published in Blood Advances.

Patients with newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) at 2 centers in the United States were recruited between 2016 and 2019. The Improving Diet and Exercise in ALL (IDEAL) trial assessed fat and lean mass alteration during a 4-week caloric deficit of at least 10% and increased caloric expenditure by a factor of 1.3 as close to initiation of chemotherapy as possible in 40 patients. Clinical outcomes were compared with a group of 80 patients who did not restrict calorie intake.

Participants in the intervention and control groups, respectively, were mean age 15.0±3.0 and 14.7±2.5 years, 60% and 54% were male, and 50% and 33% were obese at baseline.

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No change to fat mass was observed overall (P =.13). Patients who were able to adhere to the IDEAL intervention gained the least amount of fat (median change, 2.4%; interquartile range [IQR], 13.7%). Stratified by baseline weight status, those who were overweight or obese lost more fat mass (36%) than those who were lean (25%).

At study conclusion, minimal residual disease in bone marrow ³0.01% was increased among patients who were overweight or obese (odds ratio [OR], 3.40; 95% CI, 1.23-10.13; P =.01) and had higher white blood cell count (OR, 1.01; 95% CI, 1.00-1.02; P =.01) at baseline and decreased in the IDEAL intervention group (OR, 0.30; 95% CI, 0.09-0.92; P =.02).

This study was limited by its study design which used historical data as the control group.

These data indicated calorie restriction and increased caloric expenditure may improve chemotherapy efficacy among some younger patients with B-ALL.

Disclosure: One author declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Orgel E, Framson C, Buxton R, et al. Caloric and nutrient restriction to augment chemotherapy efficacy for acute lymphoblastic leukemia: the IDEAL trial. Blood Adv. 2021;5(7):1853-1861. doi:10.1182/bloodadvances.2020004018