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2016, Number 3

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Rev Hematol Mex 2016; 17 (3)

Incidence and severity of drug adverse events to methotrexate and its relationship with the dietary intake of folates in children with acute lymphoblastic leukemia

Marqués-Maldonado AP, Pérez-Armendáriz B, Romero-Plata FE, Espinosa-Arreola M, Ruiz-Argüelles GJ

Language: Spanish
References: 55
Page: 175-186
PDF size: 487.68 Kb.


ABSTRACT

Background:Acute lymphoblastic leukemia is the most common cancer among the pediatric population and the most frequent cause of death from cancer before 20 years of age. Treatment includes methotrexate, a folate antimetabolite that can cause changes of the nutritional status and therapeutic abandonment linked to relapse and a poor prognosis, due to adverse drug reactions.
Objetive: To determine the role of methotrexate dosis, nutrition status and dietary folate intake on the incidence of afverse reactions to drug.
Material and Method: A transversal and observational study was made in a group of 30 patients whit diagnosis of acute lymphoblastic leukemia receiving methotrexate from the Hematology and Intern Medicine Center of the Ruiz Clinic and from the Hospital para el Niño Poblano; the nutritional status was analyzed by anthropometry and also the dietary folate intake which was related to the incidence and severity of adverse drug reactions.
Results:Anthropometric data was obtained from 30 patients with acute lymphoblastic leukemia receiving methotrexate, finding 67% of the patients on an adequate nutritional status, 23% overweighed and 10% with minor malnutrition. About the folate intake, 20% of the patients have an adequate folate intake, 43% consumes less than the recommended dietary intake and 37% consumes a bigger amount of folates than recommended. In relation with the occurrence of adverse drug reactions, no dependency was found between the dose of methotrexate and the incidence or severity of the reactions (p=0.1088 and p=0.1644). The dietary adequacy of the folate intake did not show dependency with the incidence of adverse reactions to methotrexate (p=0.1083), the most common adverse drug reactions were nausea, diarrhea and mucositis (p=0.3673, p=0.2360, p=0.6914). It was found significant relation between the nutritional status and the incidence of adverse reactions to methotrexate (p=0.0224), but this relation was not maintained on the severity of nausea, diarrhea and mucositis (p=0.3576, p=0.5836, p=0.5338).
Conclusions: These data are consistent with those observed in other populations on the relationship between the nutritional status and the incidence of the adverse reactions to methotrexate. The relationship between the dietary intake of folates and the incidence and severity of the adverse drug reactions may suggest an independence that could be linked to the folate vitamer that is dietary consumed.


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