Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia
- 145 Downloads
To evaluate pre-treatment undernutrition, and folate and B12 deficiency in children with acute lymphoblastic leukemia, and their correlation with complications and outcome of induction chemotherapy.
Tertiary care teaching hospital in Northern India.
50 children with acute lymphoblastic leukemia.
Children were assessed for nutritional status (Weight for age Z-score, serum albumin, folate and B12) at presentation, and were followed-up during induction for bone marrow response, counts and outcome. Folate and B12 were repeated twice at monthly intervals after induction. Univariate and multivariate analyses were done to determine the association of nutritional parameters with the outcome variables.
Baseline undernutrition was observed in 66%, hypoalbuminemia in 32.6%, folate deficiency in 41.3% and B12 deficiency in 36.9% of included children. Significant decline in folate levels was noted on serial assays during chemotherapy (P=0.001). Folate deficient children had higher risk for delayed marrow recovery and counts on day 14 (P=0.007 and P=0.001). Hypoalbuminemia (P=0.04), B12 deficiency (P=0.001) and folate (P=0.03) deficiency were associated with toxic deaths during induction.
Baseline nutritional deficiencies negatively influence the outcome and occurrence of complications during induction chemotherapy in children with acute lymphoblastic leukemia.
KeywordsAcute leukemia Nutrition Outcome Protein energy malnutrition Vitamin deficiency
Unable to display preview. Download preview PDF.
- 6.World Bank. Undernutrtion Report; South Asia-India. Available from: http://web.worldbank.org/wbsite/external/countries/southasiaext/0,,contentmdk:20916955!~pagepk:146736~pipk:146830~thesitepk:223547,00.html. Accessed December 3, 2014.Google Scholar
- 10.Ortiz Z, Shea B, Suarez Almazor M, Moher D, Wells G, Tugwell P. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis. Cochrane Database Syst Rev. 2000:CD000951.Google Scholar
- 14.de Benoist B. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull. 2008;29:S238–44.Google Scholar
- 16.Common Terminology Criteria for Adverse Events version 4.0 (NCI-CTCAE v4.0)–National Cancer institute.Google Scholar
- 21.Skärby TV, Anderson H, Heldrup J, Kanerva JA, Seidel H, Schmiegelow K, et al. Nordic Society of Paediatric Haematology and Oncology (NOPHO). High leucovorin doses during high-dose methotrexate treatment may reduce the cure rate in childhood acute lymphoblastic leukemia. Leukemia. 2006;20:1955–62.Google Scholar