Chemotherapy often causes damage to hematopoietic tissues, leading to acute bone marrow suppression and the long term development of leukemias. Niacin deficiency, which is common in cancer patients, causes dramatic genomic instability in bone marrow cells in an in vivo rat model. From a mechanistic perspective, niacin deficiency delays excision repair and causes double strand break accumulation, which in turn favors chromosome breaks and translocations. Niacin deficiency also impairs cell cycle arrest and apoptosis in response to DNA damage, which combine to encourage the survival of cells with leukemogenic potential. Conversely, pharmacological supplementation of rats with niacin increases bone marrow poly (ADP-ribose) formation and apoptosis. Improvement of niacin status in rats significantly decreased nitrosoureainduced leukemia incidence. The data from our rat model suggest that niacin supplementation of cancer patients may decrease the severity of short-and long-term side effects of chemotherapy, and could improve tumor cell killing through activation of poly(ADP-ribose)-dependent apoptosis pathways. [Mol Cancer Ther 2009;8(4):725-32]
Nutritional Status and Response to ChemotherapyThe successful use of chemotherapy is usually a fine balance between effective killing of tumor cells and acceptable levels of damage to normal tissues. For many types of drugs, acute bone marrow suppression may limit the dosage of chemotherapy, and DNA damage in hematopoietic cells leads to the long term development of secondary leukemias. As the success in treating childhood cancers has improved, long term cohorts have been established to monitor the late effects of cancer and chemotherapy (1-3). These studies have found roughly a 10-fold excess in risk of mortality subsequent to 5-year survival. The main cause of mortality at this stage continues to be recurrence of the original disease, reinforcing the need for treatment efficacy, but there is a significant proportion of secondary malignancies. Following 15 years of survival, there is still a fivefold excess in mortality, and secondary malignancies become the single greatest cause of death. Secondary malignancies tend to be acute myeloid leukemias, with specific presentations and genetic aberrations associated with topoisomerase inhibitors, alkylating agents, and anthracyclines (4). Radiotherapy for cancer and benign diseases also causes increased leukemia risk (5).Nutritional status in a healthy child may erode rapidly with the onset of cancer followed by chemotherapy treatment, which tends to cause nausea and gastrointestinal dysfunction (6). Malnutrition is very common and underdiagnosed at the point of diagnosis of childhood cancers (7). Nutritional status is multifactorial and likely to have impacts on both treatment efficacy and the occurrence of side effects. This area has lacked the research commitment required to characterize the effects of different nutrients, forms of cancer, and treatment regimens. The research tends to focus on broad scale nutritional ...