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Does vitamin A prevent high-dose-methotrexate-induced D-xylose malabsorption in children with cancer?

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Abstract

Purpose

Our aim was to explore whether vitamin A has protective effect on high-dose-methotrexate (HDMTX)-induced intestinal D-xylose malabsorption in children with leukemia and lymphoma.

Patients and methods

We performed a prospective randomized unblinded study of vitamin A in 35 children with leukemia and lymphoma who were planned to receive HDMTX 3 g/m2 and 5 g/m2, respectively. Twenty-two patients (group 1) received a single dose of 180,000 IU a day before HDMTX was given, and 13 (group 2) received only HDMTX. The vitamin A group received the vitamin only once. Oral D-xylose absorption tests before and 7 days after HDMTX were carried out to evaluate intestinal absorption. Retinol-binding protein (RBP) levels prior to therapy were also measured for vitamin A status.

Results

Although we observed no difference of HDMTX-induced toxicity, including hematological, dermatological, systemic, and other toxicities, between groups, the D-xylose absorption test was significantly better in-group 1 (p=0.030). Absorption was decreased in five of 22 patients (23%) who received vitamin A comparing to eight of 13 (62%) who received only HDMTX (p=0.033). RBP levels were lower than normal in 13 of 22 patients in-group 1 and nine of 13 in group 2. In patients whose RBP levels were lower than normal, HDMTX-induced toxicity was lower in the group 1 than group 2 but not statistically significant. No sign of vitamin A toxicity was observed throughout the study.

Conclusion

The administration of vitamin A before HDMTX may protect against drug-induced D-xylose malabsorption in children with cancer. Further studies are apparently needed to clarify the full benefits of vitamin A in preventing HDMTX-induced mucosal damage.

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Acknowledgement

We thank Prof. Dr. Yuksel Bek and Prof. Dr. Murat Erturk from the Departments of Biostatistics and Microbiology of the Medical Faculty of Ondokuz Mayis University for their valuable contribution for revision of the paper.

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Authors and Affiliations

  1. Medical Faculty, Department of Pediatric Oncology, Ondokuz Mayis University, 55139, Kurupelit-Samsun, Turkey

    Ayhan Dagdemir

  2. Department of Pediatrics, Ondokuz Mayis University, Kurupelit-Samsun, Turkey

    Hasan Yildirim & Yilmaz Kanber

  3. Department of Biochemistry, Ondokuz Mayis University, Kurupelit-Samsun, Turkey

    Yuksel Aliyazicioglu

  4. Department of Pediatric Hematology, Ondokuz Mayis University, Kurupelit-Samsun, Turkey

    Davut Albayrak & Sabri Acar

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  1. Ayhan Dagdemir
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  2. Hasan Yildirim
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  3. Yuksel Aliyazicioglu
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  4. Yilmaz Kanber
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  5. Davut Albayrak
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  6. Sabri Acar
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Correspondence to Ayhan Dagdemir.

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Dagdemir, A., Yildirim, H., Aliyazicioglu, Y. et al. Does vitamin A prevent high-dose-methotrexate-induced D-xylose malabsorption in children with cancer?. Support Care Cancer 12, 263–267 (2004). https://doi.org/10.1007/s00520-004-0591-8

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  • DOI: https://doi.org/10.1007/s00520-004-0591-8

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