title: Effect of folate status and methylenetetrahydrofolate reductase genotypes on the complications and outcome of high dose methotrexate chemotherapy in north Indian children with acute lymphoblastic leukemia.
abstract: OBJECTIVE
  The genes of the folate metabolic pathway have been associated with toxicities during high dose methotrexate therapy for childhood ALL, however, the importance of intrinsic folate status in this regard is unclear.
  
  
  METHODS
  In the present study the effect of precourse folate levels and MTHFR genotypes on the complications during high dose methotrexate chemotherapy in children with ALL were examined.
  
  
  RESULTS
  Twenty-one children were studied. Folate deficiency was associated with higher incidence of neutropenia (P = 0.03) and longer duration of chemotherapy interruption (P = 0.009). Children with MTHFR1298 mutations needed more red cell transfusion (P = 0.03). All 3 deaths encountered were seen in folate deficient children.
  
  
  CONCLUSIONS
  Folate deficiency was associated with higher complications during high dose methotrexate therapy, the implications of which are important especially in resource poor settings with high prevalence of folate deficiency.
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology/Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Nirmalya Roy
authors.initials: NR
authors.lastname: Moulik
authors.affiliation: Department of Pediatrics, Division of Pediatric Hematology/Oncology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Suraksha
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Biochemistry, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Mahdi
authors.affiliation: Department of Hematopathology, King George's Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Kumar
keywords: Childhood acute lymphoblastic leukemia; folate deficiency; high-dose methotrexate