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A decrease in vitamin D levels is associated with methotrexate-induced oral mucositis in children with acute
N Oosterom1,2,3, N F Dirks4, S G Heil5
1Princess Máxima Center for Pediatric Oncology, P.O. 85090, 3508 AB, Utrecht, The Netherlands. N.Oosterom@prinsesmaximacentrum.nl.
Insights
Vitamin D deficiency is common in children with acute lymphoblastic leukemia (ALL), especially those over 4. A drop in vitamin D levels during methotrexate therapy increases the risk of severe oral mucositis.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Pharmacology
Background:
- Children with acute lymphoblastic leukemia (ALL) face a higher risk of vitamin D deficiency.
- Low vitamin D levels are linked to increased inflammation and compromised mucosal barriers.
- This study investigates vitamin D's role in methotrexate-induced oral mucositis in pediatric ALL.
Purpose of the Study:
- To determine the prevalence of vitamin D deficiency in pediatric ALL patients.
- To explore the association between vitamin D levels and methotrexate-induced oral mucositis.
- To analyze the impact of high-dose methotrexate (HD-MTX) on vitamin D levels.
Main Methods:
- Assessed 25-hydroxyvitamin D (25(OH)D3) and 24,25-dihydroxyvitamin D (24,25(OH)2D3) levels in 99 pediatric ALL patients before and after HD-MTX therapy.
- Defined vitamin D deficiency using two cutoff values (<30 nmol/L and <50 nmol/L).
- Classified oral mucositis severity using National Cancer Institute Criteria (grade ≥3).
Main Results:
- Vitamin D deficiency was observed in 8% (<30 nmol/L) and 33% (<50 nmol/L) of patients at baseline.
- Deficiency was more prevalent in children over 4 years old.
- A decrease in 25(OH)D3 levels during HD-MTX therapy correlated with severe oral mucositis (OR 1.6).
Conclusions:
- Vitamin D deficiency is frequent in pediatric ALL patients over 4 years of age.
- A decline in 25(OH)D3 levels during methotrexate treatment is associated with severe oral mucositis.
- Further research may elucidate vitamin D's role in managing mucositis in pediatric ALL.
Purpose:
Children with acute lymphoblastic leukemia (ALL) are at increased risk of vitamin D deficiency, which might make them more susceptible to developing adverse events. Previous studies showed that low vitamin D levels were associated with an increased inflammatory mucosal state and impaired mucosal tissue barriers. We examined the prevalence of vitamin D deficiency and studied the association between vitamin D levels and methotrexate (MTX)-induced oral mucositis in pediatric ALL.
Methods:
We assessed 25-hydroxyvitamin D (25(OH)D3) and 24,25-dihydroxyvitamin D (24,25(OH)2D3) levels in 99 children with ALL before the start of 4 × 5 g/m2 high-dose methotrexate (HD-MTX) (T0) and in 81/99 children after discontinuation of HD-MTX (T1). Two cutoff values for vitamin D deficiency exist: 25(OH)D3 levels < 30 and < 50 nmol/L. Oral mucositis was defined as grade ≥ 3 according to the National Cancer Institute Criteria.
Results:
Vitamin D deficiency occurred in respectively 8% (< 30 nmol/L) and 33% (< 50 nmol/L) of the patients at T0, and more frequently in children > 4 years of age as compared to children between 1 and 4 years of age. A decrease in 25(OH)D3 levels during HD-MTX therapy was associated with developing severe oral mucositis (OR 1.6; 95% CI [1.1-2.4]). 25(OH)D3 and 24,25(OH)2D3 levels at T0 and the change in 24,25(OH)2D3 levels during therapy were not associated with the development of severe oral mucositis.
Conclusions:
This study showed that vitamin D deficiency occurs frequently in pediatric ALL patients above the age of 4 years. A decrease in 25(OH)D3 levels during MTX therapy was observed in children with ALL that developed severe oral mucositis.
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