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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

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Summary

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.

Keywords:
Acute lymphoblastic leukemiaMethotrexateOral mucositisVitamin D

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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.