Moulik Nirmalya Roy, Kumar Archana, Agrawal Suraksha, Mahdi Abbas Ali, Kumar Ashutosh
Department of Pediatrics, Division of Pediatric Hematology/Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Indian J Med Paediatr Oncol. 2016 Apr-Jun;37(2):85-9. doi: 10.4103/0971-5851.180144.
The genes of the folate metabolic pathway have been associated with toxicities during high dose methotrexate therapy for childhood ALL, however, the importance of intrinsic folate status in this regard is unclear.
In the present study the effect of precourse folate levels and MTHFR genotypes on the complications during high dose methotrexate chemotherapy in children with ALL were examined.
Twenty-one children were studied. Folate deficiency was associated with higher incidence of neutropenia (P = 0.03) and longer duration of chemotherapy interruption (P = 0.009). Children with MTHFR1298 mutations needed more red cell transfusion (P = 0.03). All 3 deaths encountered were seen in folate deficient children.
Folate deficiency was associated with higher complications during high dose methotrexate therapy, the implications of which are important especially in resource poor settings with high prevalence of folate deficiency.
叶酸代谢途径的基因已被证实与儿童急性淋巴细胞白血病（ALL）大剂量甲氨蝶呤治疗期间的毒性反应有关，然而，内源性叶酸状态在这方面的重要性尚不清楚。
在本研究中，我们检测了治疗前叶酸水平和亚甲基四氢叶酸还原酶（MTHFR）基因型对ALL患儿大剂量甲氨蝶呤化疗期间并发症的影响。
共研究了21名儿童。叶酸缺乏与中性粒细胞减少症的较高发生率（P = 0.03）和化疗中断的较长持续时间（P = 0.009）相关。携带MTHFR 1298突变的儿童需要更多的红细胞输血（P = 0.03）。所有3例死亡病例均见于叶酸缺乏的儿童。
叶酸缺乏与大剂量甲氨蝶呤治疗期间较高的并发症发生率相关，这一发现的意义重大，尤其是在叶酸缺乏患病率较高的资源匮乏地区。
