Folate deficiency in north Indian children undergoing maintenance chemotherapy for acute lymphoblastic leukemia—Implications and outcome

Moulik, Nirmalya Roy; Kumar, Archana; Agrawal, Suraksha; Mahdi, Abbas Ali

doi:10.1002/pbc.26730

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…Malnutrition in children with cancer, whether it be by overnutrition or undernutrition, has been linked to poor outcomes, greater rates of treatment discontinuation, hospital stays, treatment-related toxicity, infectious complications and mortality [ 7 ]. Hypotheses have been developed that suggest malnutrition impairs the ability of the immune response against infections due to cytokine hormone function alterations [ 8 ] and micronutrient deficiencies [ 9 , 10 ]. It also impairs the effectiveness of cancer treatments because of pharmacokinetic and pharmacodynamic changes that are explained by an altered metabolic state [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study

González¹,

Mejía²,

Ortiz³

et al. 2021

ecancer

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Introduction: Paediatric cancer is a potentially curable disease and its prognosis has been linked to several factors, such as nutritional status. The impact of malnutrition on these patients, either by overnutrition or undernutrition, varies and its relationship with outcomes is inconsistent. This study was conducted in order to determine the frequency of malnutrition in children with haematolymphoid malignancies at the time of diagnosis, as well as during treatment and to also investigate its relationship with the development of infections and death. Materials and Methods:A retrospective cohort study of 191 children with a recent diagnosis of a haematolymphoid malignancy. The risks and nutritional classification were determined using anthropometry, follow-ups were conducted for up to 24 months and the presentation and frequency of infections and/or death were also recorded. Bivariate and multivariate analyses were conducted using binomial logistic regressions, for death and infection outcomes during follow-up. Survival analysis was conducted for various factors and types of cancer.Results: 83.7% of children had a sufficient nutritional classification at diagnosis, 6.8% had malnutrition by undernutrition and 9.4% by overnutrition. 83.8% had at least one infectious complication during follow-up and 47.1% had ≥ 3. This percentage increased to 69.2% when configuring it in the malnutrition by undernutrition group. 18.3% of patients died. When configuring the mortality, the percentage was greater in patients with Acute Myeloid Leukaemia (AML) (57.1%) and malnutrition by undernutrition (30.7%). The multivariate analysis for the outcome of death, only showed a statistically significant variable (AML odds ratio = 26.52; confidence interval = 1.09-643.24; p = 0.04). Conclusion:No statistically significant relationship was found between the nutritional status of children with haematolymphoid neoplasms, and outcomes such as infections or Research

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Section: Introductionmentioning

confidence: 99%

Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study

González¹,

Mejía²,

Ortiz³

et al. 2021

ecancer

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“…3 Akut lenfoblastik lösemi tanılı çocuklarda da idame tedavisi sırasında metotreksat (MTX)'ın yan etkisi olarak folik asit eksikliği ortaya çıkabilir. 4 Bu olgu sunumunda, ALL tanısıyla idame kemoterapisi aldığı sırada halsizlik ve burun kanaması nedeniyle kliniğimize başvuran ve pansitopeni tespit edilen bir hastamızın etyolojisinde folik asit eksikliği saptadığımızı belirterek konunun önemini vurgulamayı amaçladık. ateşi ve splenomegalisi olmaması, trigliserid ve fibrinojen seviyelerinin normal olması ve kemik iliği incelemesinde blast ve belirgin hemofagositoz saptanmaması üzerine relaps ALL ve HLH tanıları ekarte edildi.…”

Section: Introductionunclassified

“…9 Diğer yandan, idame tedavisi alan ve folik asit eksikliği olan ALL tanılı çocuklarda nötropeni ve trombositopeni gibi tedaviye bağlı komplikasyonların yaygın olup bazı çocuklarda kemoterapi dozunun azaltılmasını gerektirdiğini belirten çalışmalar da bulunmaktadır. 4 Kennedy ve arkadaşları da folik asit desteği ve MTX tedavisi arasındaki bağlantıyı araştırmışlar ve folik asit tedavisinin idame tedavisi alan ALL'li çocuklarda herhangi bir olumsuzluğa yol açmadığını belirtmişlerdir. 10 Akut lenfoblastik lösemili çocuklarda idame tedavisi sırasında folik asit eksikliği gelişebileceği akılda tutulmalı ve açıklanamayan pansitopeni varlığında serum kobalamin ve folik asit düzeyi kontrol edilmelidir.…”

Section: Introductionunclassified

Akut Lenfoblastik Lösemili Çocuklarda İdame Tedavisinin Nadir Bir Komplikasyonu: Folik Asit Eksikliği

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Erkun

Pala

et al. 2020

Online Türk Sağlık Bilimleri Dergisi

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ÖZVitamin B12 (Kobalamin) ve folik asit; DNA yapımında, hücre bölünmesi ve çoğalmasında rol alan ve eksikliğinde hematopoetik, sinir ve sindirim sisteminde ciddi hastalıklara yol açabilen vitaminlerdir. Akut Lenfoblastik Lösemi (ALL) nedeniyle idame tedavisi (metotreksat, 6merkaptopurin) alan 14 yaşında kız hasta solukluk ve burun kanaması şikâyetiyle kliniğimize başvurduğunda beyaz kan hücresi (white blood cells, WBC): 2230/mm 3 , hemoglobin: 6,2 gr/dL, ortalama korpüsküler hacmi (mean corpuscular volume, MCV): 122 fL ve trombosit: 26700/ mm 3 idi. Periferik yaymasında hipersegmente nötrofiller, makrositer eritrositler, belirgin anizositoz, nadir normoblast ve her sahada 4-5 trombosit izlendi. Relaps ALL, aplastik kriz, megaloblastik anemi, hemofagositik lenfohistiyositoz (HLH) ve miyelodisplastik sendrom (MDS) ön tanılarıyla yatırılan hastanın kemik iliği aspirasyonbiyopsi değerlendirmesi sonucunda relaps olmadığı anlaşıldı. Başvuru sırasında istenen Vitamin B12 587 pg/mL, folik asit 1,3 ng/mL ve homosistein 21 µmol/L saptanması üzerine Vitamin B12 ve folik asit tedavisi başlandı. ALL'li çocuklarda idame tedavisinde folik asit eksikliği gelişebileceği unutulmamalı ve açıklanamayan pansitopeni varlığında serum kobalamin ve folik asit düzeyi bakılmalıdır.

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“…Folate intake has also been associated with acute lymphocytic leukemia (ALL) risk and treatment outcome. Folic acid deficiency was associated with complications and adverse outcomes in children in India with ALL during maintenance chemotherapy 65 . In vitro studies have shown that human lymphocytes cultured in low FA concentrations have increased DNA instability, strand breakage, and uracil misincorporation 66 .…”

Section: Fa Deficiency and Neural Tube Defectsmentioning

confidence: 99%

“…Finally, folic acid deficiency was associated with complications and adverse outcomes in children in India with ALL during maintenance chemotherapy 65 . SNP 80G>A in the RFC1 gene, the reduced folate carrier, is associated with low plasma folate and high homocysteine concentrations in healthy persons 163 .…”

Section: Introductionmentioning

confidence: 99%

Folate induced mutagenesis and identification of folate-specific mutation profiles in somatic cells

Gonzalez¹

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Folate is an essential water soluble B-vitamin required for the de novo synthesis of purines and dTMP and the synthesis of methionine. Disruption of any of the three folatedependent biosynthetic pathways has been shown to have serious implications in a cell's survival and an individual's disease risk. Folate, generally folate deficiency, has been associated with colorectal cancer (CRC) and acute lymphocytic leukemia (ALL) in epidemiological studies. However, CRC risk has also been associated with high FA intake. Previous studies have shown that FA deficiency induces higher mutant frequency (MF) in bone marrow in addition to increasing chromosomal instability in RBC. Here, we used the MutaMouse model to determine the mutagenic potential of dietary FA in the colon, and to determine if there is a tissue-and diet-specific effect induced by FA intake in colon and bone marrow. Male mice were fed experimental FA defined diets: deficient (0 mg/kg), control (2 mg/kg) and supplemented (8 mg/kg) for 20 weeks from weaning. To determine First and foremost, I would like to thank the amazing Dr. Amanda MacFarlane who besides being an incredible scientist and my supervisor, she has also become a mentor and a role model inside and outside the lab. Also thank you for being so understanding, supporting and for embracing my uniqueness and culture ;). Thank you, Dr. Alex Wong, for all your teachings and being my first formal introduction into programming. You and Dr. MacFarlane are not only two exemplary scientists but also individuals and parents. Also, a special thanks to my thesis supervisory committee, Dr.

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Folate deficiency in north Indian children undergoing maintenance chemotherapy for acute lymphoblastic leukemia—Implications and outcome

Cited by 10 publications

References 15 publications

Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study

Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study

Akut Lenfoblastik Lösemili Çocuklarda İdame Tedavisinin Nadir Bir Komplikasyonu: Folik Asit Eksikliği

Folate induced mutagenesis and identification of folate-specific mutation profiles in somatic cells

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