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


METHODS
We performed a prospective randomized un-blinded study of vitamin A in 35 children with leukemia and lymphoma who were planned to receive HDMTX 3 g/m(2) and 5 g/m(2), 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.


CONCLUSIONS
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.
Dagdemir
Ayhan
A
Medical Faculty, Department of Pediatric Oncology, Ondokuz Mayis University, 55139 Kurupelit-Samsun, Turkey. ayhandag@omu.edu.tr
Yildirim
Hasan
H
Aliyazicioglu
Yuksel
Y
Kanber
Yilmaz
Y
Albayrak
Davut
D
Acar
Sabri
S
D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D007413:Intestinal Mucosa / Q000187:drug effects; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008286:Malabsorption Syndromes / Q000139:chemically induced*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies; D020011:Protective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D012177:Retinol-Binding Proteins / Q000032:analysis; D014801:Vitamin A / Q000008:administration & dosage / Q000627:therapeutic use*; D014994:Xylose / Q000378:metabolism*
D000964:Antimetabolites, Antineoplastic; D020011:Protective Agents; D012177:Retinol-Binding Proteins; D014801:Vitamin A; D014994:Xylose; D008727:Methotrexate