Effect of pre-treatment nutritional status, folate and vitamin B12 levels on induction chemotherapy in children with acute lymphoblastic leukemia

Abstract

Baseline nutritional deficiencies negatively influence the outcome and occurrence of complications during induction chemotherapy in children with acute lymphoblastic leukemia.

Nutritional Considerations in Childhood Acute Lymphoblastic Leukemia

“…Moreover, vitamin B12 deficient individuals were verified with dysfunctional immunity (both cellular and humeral), low CD4 and CD8 counts, lessened natural killer (NK) cells function and low immunoglobin levels. This might explain the elevated toxic death hazards noticed in vitamin B12 deficient children being observed (Table 2) (Tandon, 2015). (Tandon, 2015).…”

“…B12 deficiency was associated with hematopoiesis disorders and immune response dysfunction inducing an increase in the infection susceptibility. An increase in chemotherapy induced toxicity in rats was demonstrated with folate deficiency and its repletion has been established to alleviate methotrexate toxicity in adults suffering fro m rheumatological diseases (Tandon, 2015).…”

“…33 (66%) were shown with undernutrition and about 19 (38%) and 17 (34%) had folate and vitamin B12 pre-induction deficiencies, respectively. Four of the children were excluded from the analysis and in the remaining 46, 17 (40%) suffered from toxic deaths during induction phase, leaving 29 survivers for post-induction (Tandon, 2015). Upon the initial 2 months of chemotherapy serial folate levels examined a persistant and critical decline as shown in figure 4 below (Tandon, 2015).…”

“…This might explain the elevated toxic death hazards noticed in vitamin B12 deficient children being observed (Table 2) (Tandon, 2015). (Tandon, 2015). Table 2 shows common outcomes associated with folate deficiency as incomplete bone marrow recovery at day 14, delayed peripheral blood counts recovery and toxic induction deaths during induction phase compared to folate replete.…”

Reply to: Comment on: Successful use of nitrous oxide during lumbar punctures: A call for nitrous oxide in pediatric oncology clinics

“…In the NHANES 2003–2006 study, vitamin B‐12 concentration <200 pg/ml in normal children in the United States was exceedingly rare and seen in only 24 of 5,382 children (0.4%) . There are data to suggest that low B‐12 levels are seen in one‐third of ALL patients from third‐world countries due to malnourishment . This is a group of patients in whom nitrous oxide should be used with caution.…”