title: Folate fortification and survival of children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  The antifolate drug methotrexate is a mainstay of treatment for children diagnosed with acute lymphoblastic leukemia (ALL). There have been concerns regarding the impact of folate fortification on the efficacy of methotrexate therapy and hence treatment outcomes of ALL.
  
  
  OBJECTIVE
  The objective of this study was to evaluate whether folate fortification has been associated with a higher incidence of adverse outcomes in children with ALL.
  
  
  METHODS
  In a retrospective, population-based study, using data from the Pediatric Oncology Group of Ontario (POGO), Ontario, Canada, and the WHO, we examined yearly and population-adjusted mortality rates in Canada, the US, and several European countries.
  
  
  RESULTS
  Our analysis demonstrates that there has been a decreasing trend in ALL mortality numbers and rates between 1999 and 2005 in the US and Canada, in a similar degree to those in European countries where folate fortification is not implemented.
  
  
  CONCLUSIONS
  These data suggest that folate fortification does not appear to have caused an increase in therapeutic failures in children with ALL.
authors.affiliation: The Motherisk Program, The Hospital for Sick Children, Toronto, Ontario, Canada. dkennedy@ccnm.edu
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kennedy
authors.forename: Sandy
authors.initials: S
authors.lastname: Grupp
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.forename: Gideon
authors.initials: G
authors.lastname: Koren
mesh_terms: D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005492:Folic Acid / Q000009:adverse effects*; D005493:Folic Acid Antagonists / Q000627:therapeutic use; D005527:Food, Fortified / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008727:Methotrexate / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D014944:World Health Organization
chemical_list: D005493:Folic Acid Antagonists; D005492:Folic Acid; D008727:Methotrexate