Serum Carnitine Levels in Childhood Leukemia

Abstract

In patients with malignancies, the system of carnitine seems abnormally expressed. The serum total, free, and acyl carnitine levels in 40 children and adolescents with acute leukemia were determined using electrospray tandem mass spectrometry in 4 different phases of the disease: at the diagnosis, 1 year after the initiation of chemotherapy, at the end of treatment, and 2.4+/-1.668 years after the completion of chemotherapy. The age, sex, hemoglobin values, serum biochemistry, somatometric features of the patients, and the risk group of the disease were examined. Although the carnitine levels were found higher in patients compared with the control group from diagnosis to treatment completion, statistically significant decrease in carnitine levels was observed in patients within different phases of the disease especially during induction and consolidation treatment (phase A to B) for both free and total (P=0.023) carnitine. In addition, a statistically significant recovery in carnitine levels was observed between phase B (end of intensive chemotherapy) and D (some years after the completion of treatment) for free and total carnitine (P=0.054 and 0.035, respectively). No statistical correlation was documented between the carnitine levels and somatometric parameters or other variables studied. In conclusion, a significant transient decrease in the levels of carnitine during the treatment was observed in children with acute leukemia. Further studies are required to clarify the role of carnitine status in patients with malignancies and possibly the necessity of carnitine supplementation during chemotherapy administration.

Fatigue and carnitine levels over multiple cycles of chemotherapy in children and adolescents

“…In our sample of 58 patients, levels of total and free carnitine that were obtained 15e29 days into a treatment cycle remained stable and within the reference range for children over the trajectory of multiple cycles of chemotherapy. This is consistent with recent studies that found that carnitine levels had either transient changes that recovered spontaneously (Rogalidou et al, 2010) or had no change (Khositseth et al, 2011). As 75% of carnitine is obtained from the diet (Flanagan et al, 2010), perhaps improved standards in nutrition and supportive care in pediatric cancer patients have positively influenced their ability to maintain carnitine levels during chemotherapy.…”

“…After three months of treatment, the children with cancer had a significant decrease in carnitine levels and these measurements were significantly different than the healthy controls (Yaris et al, 2002). Rogalidou et al (2010) studied 40 children and adolescents with acute leukemia over the trajectory of treatment and survivorship, measuring carnitine levels at diagnosis, after 1 year of treatment, at the end of treatment and 2 years after treatment. There was a significant, transient decrease in total and free carnitine during the first year of treatment with levels recovering after treatment.…”

A cross-sectional study of carnitine deficiency and fatigue in pediatric cancer patients

“…Of the 67 subjects, a significant negative correlation between fatigue and total and free carnitine levels (higher fatigue and lower carnitine levels) 1 week after chemotherapy was found in 22 adolescents who had received prior chemotherapy. Rogalidou et al [19] evaluated serum total and free carnitine levels in 40 children with acute leukemia at various time points and concluded that the reduction in carnitine levels seen was not correlated with age, sex, nutritional status, and leukemia risk group or hemoglobin level. Yaris et al [20] examined the relationship between serum total carnitine levels and nutritional status in 51 children (ages 3–16.5 years at diagnosis) with lymphoma or solid tumor at diagnosis and 3 months after initiation of treatment.…”

The Effect of Chemotherapy on Serum Carnitine Levels and Fatigue in Chemotherapy Naive Medical Oncology Patients: A Pilot Study. Carnitine, Chemotherapy and Fatigue

“…However, while the number of participants included in this trial was small, it was similar to multiple previous trials in this area with some studies recruiting between 5-40 participants. For example, Rogalidou et al [6] investigated the effect of chemotherapy on serum carnitine levels in 40 participants using a similar study design; however, this study recruited children and adolescents only and may not be representative of carnitine metabolism in an adult population. Despite the limitations of our study, this pilot study provides a greater insight into the carnitine status of adult chemotherapy patients in a real clinical setting.…”

“…Multiple studies have evaluated carnitine status in oncology patients undergoing chemotherapy using serum and/or urinary markers of carnitine [4][5][6][7][8][9][10][11]. While not all studies found that chemotherapy resulted in carnitine deficiency, all studies found carnitine metabolism to be significantly impaired during the study period.…”