Associations of Ferritin and Folate Status With Clinical Outcomes in Childhood Cancer Patients: A Prospective Cohort Study

IF 2.4 3区医学 Q2 HEMATOLOGY

Pediatric Blood & Cancer Pub Date : 2025-03-07 DOI:10.1002/pbc.31645

Kalum Withey, Mark F. H. Brougham, Ilenia Paciarotti, Jane M. McKenzie, David C. Wilson, Raquel Revuelta Iniesta

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Abstract

Background

Given the limited research on folate and ferritin status in children with cancer undergoing treatment, we investigated the prevalence of abnormalities and their impact on clinical outcomes and treatment complications.

Methods

This prospective cohort study enrolled children <18 years diagnosed with cancer between August 2010 and February 2014. Data collection occurred at diagnosis, 3, 6, 9, 12 and 18 months. Clinical outcomes were classified as event-free survival or events (relapse, death, the development of new metastasis, becoming palliative) and treatment complications. Micronutrient status was assessed through clinical and nutritional analyses. Binary logistic regression, multilevel model analysis explored relationships between micronutrient status and clinical outcomes.

Results

Eighty-two patients (median [interquartile range] 3.9 (1.9–8.8) years, 56% males) were recruited. Excess ferritin (85%) and folate deficiency (25.5%) were prevalent micronutrient abnormalities throughout the study. Decreased ferritin levels reduced the odds of events by 83.9% (odd ratios = 0.161, 95% CI = 1.000–1.002, p = 0.032). Higher ferritin was associated with increased number of treatment-related complications (B = 7.3E−5, 95% CI = 1.5E−5–0.000, p = 0.013). Folate status showed significant association with body mass index category (χ²= 9.564, p = 0.008), indicating that overweight and obese patients were more prone to deficiency, and methotrexate (F(2.9); p = 0.06; −2LL (1381)). Haematological malignancies (F(2.8); p = 0.05; −2LL (4244)) and medium and high treatment intensity (F(2.4); p = 0.09; −2LL 4262)) were associated with higher ferritin levels over 18 months.

Conclusions

Paediatric cancer patients undergoing treatment exhibit high ferritin and reduced folate levels. Elevated ferritin is linked to increased toxicity and negative clinical outcomes, highlighting the importance of regular assessment and monitoring of both folate and ferritin. Implementing routine monitoring for these biomarkers could help mitigate adverse effects associated with treatment. Large-scale population-based studies and clinical trials are now warranted.

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铁蛋白和叶酸状态与儿童癌症患者临床结局的关联：一项前瞻性队列研究。

背景：鉴于对接受治疗的癌症儿童叶酸和铁蛋白状况的研究有限，我们调查了异常的患病率及其对临床结局和治疗并发症的影响。结果：纳入82例患者（中位数[四分位数间距]3.9（1.9-8.8）岁，56%为男性）。铁蛋白过量（85%）和叶酸缺乏（25.5%）是整个研究中普遍存在的微量营养素异常。铁蛋白水平降低使事件发生的几率降低了83.9%（奇比= 0.161,95% CI = 1.000-1.002, p = 0.032）。高铁蛋白与治疗相关并发症数量增加相关（B = 7.3E-5, 95% CI = 1.5E-5-0.000, p = 0.013）。叶酸状况与体重指数类别有显著相关性（χ2 = 9.564, p = 0.008），表明超重和肥胖患者更容易出现叶酸缺乏，甲氨蝶呤(F(2.9)；p = 0.06；2(1381))。血液学恶性肿瘤(F(2.8)；p = 0.05；-2LL(4244))和中高处理强度(F(2.4)；p = 0.09；-2LL 4262))与18个月内较高的铁蛋白水平相关。结论：接受治疗的儿科癌症患者表现出高铁蛋白和低叶酸水平。铁蛋白升高与毒性增加和负面临床结果有关，强调了定期评估和监测叶酸和铁蛋白的重要性。对这些生物标志物进行常规监测有助于减轻与治疗相关的不良反应。现在有必要进行大规模的人群研究和临床试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Blood & Cancer 医学-小儿科

CiteScore

4.90

自引率

9.40%

发文量

546

审稿时长

1.5 months

期刊介绍： Pediatric Blood & Cancer publishes the highest quality manuscripts describing basic and clinical investigations of blood disorders and malignant diseases of childhood including diagnosis, treatment, epidemiology, etiology, biology, and molecular and clinical genetics of these diseases as they affect children, adolescents, and young adults. Pediatric Blood & Cancer will also include studies on such treatment options as hematopoietic stem cell transplantation, immunology, and gene therapy.