Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Columbia University Medical Center, New York, NY.
Institute of Human Nutrition, Columbia University, New York, NY.
J Clin Oncol. 2020 Jul 1;38(19):2151-2159. doi: 10.1200/JCO.19.02555. Epub 2020 Apr 24.
The benefits and risks of supplementation with antioxidants during cancer therapy have been a controversial area. Few studies have systematically evaluated dietary intake of antioxidants with toxicity and survival in childhood cancer. We sought to determine the role of dietary intake of antioxidants on rates of infections, mucositis, relapse, and disease-free survival during induction and postinduction phases of therapy among children and adolescents with acute lymphoblastic leukemia (ALL).
We enrolled 794 children in a prospective clinical trial for treatment of ALL. Dietary intake was prospectively evaluated by a food frequency questionnaire. The association between dietary intake of antioxidants and treatment-related toxicities and survival were evaluated with the Benjamini-Hochberg false discovery rate (q) and logistic regression and the Kaplan-Meier method, respectively.
Dietary surveys were available for analysis from 614 (77%), and 561 (71%) participants at diagnosis and at end of induction, respectively. Of 513 participants who completed the dietary surveys at both time points, 120 (23%) and 87 (16%) experienced a bacterial infection and 22 (4%) and 55 (10%) experienced mucositis during the induction or postinduction phases of treatment, respectively. Increased intake of dietary antioxidants was associated with significantly lower rates of infection and mucositis. No association with relapse or disease-free survival was observed. Supplementation was not associated with toxicity, relapse, or survival.
Consumption of antioxidants through dietary intake was associated with reduced rates of infection or mucositis, with no increased risk of relapse or reduced survival. Dietary counseling on a well-balanced diet that includes an array of antioxidants from food sources alone may confer a benefit from infections and mucositis during treatment of childhood ALL.
癌症治疗期间补充抗氧化剂的益处和风险一直是一个有争议的领域。很少有研究系统地评估抗氧化剂的饮食摄入量与儿童癌症的毒性和生存情况。我们旨在确定饮食中抗氧化剂的摄入量在儿童和青少年急性淋巴细胞白血病（ALL）治疗的诱导期和诱导后阶段对感染、黏膜炎、复发和无病生存的影响。
我们招募了 794 名儿童参加治疗 ALL 的前瞻性临床试验。通过食物频率问卷前瞻性评估饮食摄入量。用 Benjamini-Hochberg 假发现率（q）和逻辑回归以及 Kaplan-Meier 方法分别评估抗氧化剂的饮食摄入与治疗相关毒性和生存之间的关系。
从 614 名（77%）和 561 名（71%）参与者中获得了诊断时和诱导结束时的饮食调查分析数据。在完成了两个时间点饮食调查的 513 名参与者中，分别有 120 名（23%）和 87 名（16%）在诱导期或诱导后阶段发生了细菌感染，分别有 22 名（4%）和 55 名（10%）发生了黏膜炎。饮食中抗氧化剂摄入量的增加与感染和黏膜炎发生率的显著降低相关。但未观察到与复发或无病生存相关的情况。补充剂与毒性、复发或生存均无关联。
通过饮食摄入抗氧化剂与感染或黏膜炎发生率降低有关，但不会增加复发风险或降低生存。对儿童 ALL 治疗期间从食物来源获取各种抗氧化剂的均衡饮食进行营养咨询可能有助于减少感染和黏膜炎的发生。
