The impact of pretreatment serum cobalamin and folate levels on complications and peripheral blood recovery during induction chemotherapy of leukemia: a cross-sectional study

We aimed to evaluate the impact of pretreatment folate and vitamin B₁₂ deficiencies on the frequency of complications and peripheral blood recovery, in children with acute lymphoblastic leukemia (ALL).

Pre-induction serum folate and vitamin B₁₂ levels of 88 newly diagnosed ALL patients were evaluated retrospectively. Folate < 3 ng/mL and vitamin B₁₂ < 200 pg/mL were accepted as deficiency. Median hemoglobin, absolute neutrophil count (ANC), and platelet counts, transfusion needs, and complications such as mucositis, febrile neutropenia (FN), bleeding at diagnosis, at 15th and 33rd day of induction, were assessed. Recovery of peripheral blood count, which was defined as an ANC > 1.0 × 10⁹/L and platelet count > 100 × 10⁹/L at 33rd day of chemotherapy were also evaluated.

Folate or vitamin B₁₂ deficiencies were observed in 21 (23%) and 40 (45%) children, respectively. Peripheral blood counts, complications rates, and transfusion needs were not statistically different between deficient and normal level groups during induction. The number of febrile days, though not statistically significant, was higher in the both deficient groups. Seventeen of 40 (42.5%) patients with vitamin B₁₂-deficient and 12 of 21 (57.1%) folate-deficient patients experienced at least one episode of FN during induction. FN was more common in folate-deficient group, but that was not statistically significant. Complete peripheral blood recovery at 33rd day of induction was seen in 40% in the vitamin B12-deficient group and 28.6% in folate-deficient group. Peripheral blood recovery rate at day 33 was also similar in both deficient and normal level groups.

Although pre-induction low serum levels of vitamin B₁₂ and folate did not have statistically significant impact on disease-/treatment-related complications and peripheral blood recovery at induction, the frequency of FN and number of febrile day were higher in both deficiencies and folate-deficient patients, respectively.