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Associations of Ferritin and Folate Status With Clinical Outcomes in Childhood Cancer Patients: A Prospective Cohort
Kalum Withey1, Mark F H Brougham2, Ilenia Paciarotti3,4
1Department of Public Health and Sports Sciences, Medical School, Children's Health and Exercise Research Centre, University of Exeter, St Luke's Campus, University of Exeter, Exeter, UK.
Insights
Children with cancer often have high ferritin and low folate levels. Monitoring these micronutrients can help reduce treatment complications and improve outcomes.
Area of Science:
- Pediatric Oncology
- Nutritional Science
- Clinical Research
Background:
- Limited research exists on folate and ferritin status in pediatric cancer patients during treatment.
- Understanding these micronutrient levels is crucial for managing clinical outcomes and treatment complications.
Purpose of the Study:
- To investigate the prevalence of folate and ferritin abnormalities in children undergoing cancer treatment.
- To determine the impact of these micronutrient abnormalities on clinical outcomes and treatment complications.
Main Methods:
- A prospective cohort study included children under 18 diagnosed with cancer.
- Data on clinical outcomes, treatment complications, and micronutrient status were collected over 18 months.
- Statistical analyses, including binary logistic regression and multilevel models, were used to explore associations.
Main Results:
- High ferritin (85%) and folate deficiency (25.5%) were prevalent in the study population.
- Lower ferritin levels were associated with reduced odds of adverse events (OR=0.161, p=0.032).
- Higher ferritin levels correlated with more treatment-related complications (B=7.3E-5, p=0.013) and were linked to hematological malignancies and treatment intensity.
Conclusions:
- Pediatric cancer patients frequently exhibit elevated ferritin and reduced folate levels.
- Elevated ferritin is associated with increased treatment toxicity and poorer clinical outcomes.
- Routine monitoring of folate and ferritin is recommended to mitigate adverse effects and improve patient management.
Background:
Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications.
Methods:
This prospective cohort study enrolled children <18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event-free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes.
Results:
Eighty-two patients (median [interquartile range] 3.9 (1.9-8.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios = 0.161, 95% CI = 1.000-1.002, p = 0.032). Higher ferritin was associated with increased number of treatment-related complications (B = 7.3E-5, 95% CI = 1.5E-5-0.000, p = 0.013). Folate status showed significant association with body mass index category (χ2 = 9.564, p = 0.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate (F(2.9); p = 0.06; -2LL (1381)). Haematological malignancies (F(2.8); p = 0.05; -2LL (4244)) and medium and high treatment intensity (F(2.4); p = 0.09; -2LL 4262)) were associated with higher ferritin levels over 18 months.
Conclusions:
Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large-scale population-based studies and clinical trials are now warranted.
