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Folate deficiency in north Indian children undergoing maintenance chemotherapy for acute lymphoblastic

Nirmalya Roy Moulik1, Archana Kumar2, Suraksha Agrawal3

  • 1Department of Paediatrics, Royal Marsden Hospital, Sutton, Greater London, United Kingdom.

Pediatric Blood & Cancer
|August 3, 2017
PubMed

Insights

Folate deficiency is common in children with acute lymphoblastic leukemia (ALL) undergoing maintenance chemotherapy in India. This deficiency increases the risk of treatment complications and mortality, highlighting the need for further research into supplementation.

Area of Science:

  • Pediatric Oncology
  • Hematology
  • Nutritional Science

Background:

  • Treatment-related toxicity and mortality are significant concerns during maintenance chemotherapy for childhood acute lymphoblastic leukemia (ALL), particularly in low- and middle-income countries (LMICs).
  • Undernutrition and micronutrient deficiencies are prevalent in children undergoing ALL treatment in LMICs.
  • This study investigates the prevalence and clinical impact of folate deficiency in North Indian children with ALL during maintenance therapy, considering antifolate drug use and high population folate deficiency rates.

Purpose of the Study:

  • To examine the prevalence of folate deficiency in children with ALL during maintenance chemotherapy.
  • To assess the clinical implications of folate deficiency, including treatment complications and mortality.
  • To explore the association between folate deficiency and adverse outcomes in this patient population.

Main Methods:

  • Assessed pre-cycle folate levels and deficiency in children with ALL.
  • Determined weight-for-age z-scores and serum albumin levels.
  • Correlated folate status with treatment complications and mortality during maintenance therapy.

Main Results:

  • Folate deficiency was identified in 29 of 52 children during maintenance chemotherapy.
  • Folate-deficient children experienced significantly higher rates of neutropenia, thrombocytopenia, febrile neutropenia, and chemotherapy dose reductions.
  • Folate deficiency was associated with increased maintenance deaths and lower survival rates, and independently linked to febrile neutropenia and mortality.

Conclusions:

  • Folate deficiency is a significant risk factor for treatment complications and adverse outcomes in children with ALL undergoing maintenance chemotherapy.
  • The potential benefits and risks of folate supplementation in deficient children require investigation through well-designed randomized trials in similar settings.
Abstract

Keywords:
ALL maintenanceclinical implicationsfolate deficiency

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