Red blood cell methotrexate and folate levels in children with acute lymphoblastic leukemia undergoing therapy: a Pediatric Oncology Group pilot study
Abstract
We enrolled children with acute lymphoblastic leukemia (ALL) in a Pediatric Oncology Group (POG) pilot study to monitor erythrocyte (RBC) methotrexate (MTX) and folate (F) levels before and during treatment. The mean value for RBCF at diagnosis was 0.86 +/- 0.46 nmol/ml RBC in the 214 patients who achieved remission and 1.21 +/- 0.74 nmol/ml RBC in the 10 patients who did not (P = 0.020). Folate levels tended to increase during remission induction, but they dropped following an intensive consolidation with methotrexate to levels that were sustained throughout chemotherapy treatment. Methotrexate levels reached mean values of approximately 0.15 nmol/ml RBC at the end of an intensive methotrexate consolidation, then fell to levels that were sustained throughout maintenance therapy. There was a weak correlation between improved event-free survival and higher RBCMTX levels after consolidation, but no correlation was found between improved survival and the level of RBCMTX or RBCF during maintenance therapy. A larger study with more complete data is needed to determine whether RBCMTX or RBCF might be useful in predicting event-free survival in patients with ALL.
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MTX targets folate synthesis.
“One commonly suspected chemotherapy agent is MTX, which targets folate synthesis (Graham et al., 1992; Pak, Chan, & Mattson, 2003).”
From Brain structure, working memory and response inhibition in childhood leukemia survivors (2017) · cites this paper as Graham et al., 1992
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References 43 · Cited by 21
- Authors
- Graham, M. L., Shuster, J. J., Kamen, B. A., Cheo, D. L., Harrison, M. P., Leventhal, B. G., Pullen, D. J., & Whitehead, V. M.
- Affiliations
- Johns Hopkins Hospital (US)
- University of Florida (US)
- The University of Texas Southwestern Medical Center (US)
- University of Mississippi (US)
- Montreal Children's Hospital (CA)
- ORCID
- Shuster, Jonathan J.
- Venue
- Cancer Chemotherapy and Pharmacology
- Published
- 1992
- Volume
- 31
- Issue
- 3
- Pages
- 217-222
- ISSN
- 0344-5704 (ISSN-L)
- 1432-0843
- OpenAlex
- W2079608086
- Cited by
- 21
- References
- 43
- Citations by year
- 2019: 1 · 2016: 2 · 2015: 1 · 2014: 2
- FWCI
- 0.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Cancer Chemotherapy and Pharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u10ca028476-22)
- National Cancer Institute (CA30969, CA 28476, U10CA030969, CA 29139, U10CA029139)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Acute Lymphoblastic Leukemia research
- Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinoids in leukemia and cellular processes
- Keywords
- acute lymphoblastic leukemia, methotrexate, folic acid, drug monitoring, maintenance therapy, event-free survival, pediatric leukemia, remission induction
- MeSH terms
- Antineoplastic Combined Chemotherapy Protocols, Child, Leucovorin, Erythrocytes, Folic Acid, Humans, Methotrexate, Remission Induction, Time Factors, Drug Monitoring, Precursor Cell Lymphoblastic Leukemia-Lymphoma
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