Omega-3 fatty acids in pediatric acute lymphocytic leukemia: A scoping review

Acute Lymphocytic Leukemia (ALL) accounts for 25% of all pediatric cancers. Experimental evidence suggests that omega-3 polyunsaturated fatty acids (n-3), particularly eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), can play a significant role in cancer treatment by inhibiting cell proliferation, inducing apoptosis enhancing chemosensitivity, and modulating cachexia-related processes. This scoping review aimed to identify studies investigating the use of n-3 in pediatric ALL, and to describe the variability of observed responses. In vitro studies show that DHA exerts dose- and time-dependent cytotoxic effects in Jurkat cells, promoting apoptosis via pro-apoptotic pathways. Additionally, DHA demonstrates synergistic cytotoxic effects when combined with chemotherapeutic agents, without evidence of toxicity in normal cells. In clinical settings, n-3 fatty acids have shown cardioprotective and hepatoprotective effects against chemotherapy-induced toxicity during both induction and maintenance phases in pediatric ALL, without compromising therapeutic efficacy. Overall, the evidence remains limited and heterogeneous. While experimental findings suggest cytotoxic effects in leukemic cells and potential modulation of toxicity in normal tissues, clinical data are insufficient to support definitive conclusions. Further well-designed studies are required to clarify the mechanisms of action, as well as the efficacy and safety of n-3 supplementation in pediatric patients with ALL.