BACKGROUND Anemia is a common finding and important cause of morbidity in patients with acute lymphoblastic leukemia (ALL) at diagnosis or during the course of its protracted treatment. We studied profile of anemia in ALL patients on maintenance therapy and evaluated specific micronutrients as cause of this anemia. PATIENTS AND METHODS ALL patients who were on maintenance therapy and had grade ≥ 2 anemia were recruited for the study. Serum iron studies, folate, and vitamin B12 were done to identify micronutrient deficiency and to initiate supplementation with specific components if found to be deficient. Toxicities, improvement of anemia, micronutrient levels, and disease outcome were studied after 3 months. RESULTS From March 2015 to September 2016, 105 ALL patients were found to be on maintenance fulfilling the inclusion criteria. Overall, the proportion of anemia was 80%(N = 84). Majority had normocytic normochromic anemia (71%). Macrocytic anemia was seen in 18% and microcytic hypochromic in 9.5%. In patients with anemia of grade ≥ 2 (N = 84), 38 patients (45%) had biochemical deficiency of serum folate, and 7 (8%) had vitamin B12 deficiency. No biochemical evidence of iron deficiency was found. Supplementation of deficient micronutrients improved anemia: mean hemoglobin significantly increased from 8.06 ± 1.63 to 10.78 ± 1.53 (p < 0.001) at 3 months; and reduced treatment toxicities, mean number of febrile neutropenia episodes (p = 0.007), and treatment interruptions of > 2 weeks (p = 0.002) were lowered. Patients with anemia had significantly more relapses (N = 14,64%) compared to patients without anemia (N = 8,36%), (p = 0.040). CONCLUSION Timely identification and correction of micronutrient deficiencies causing anemia in ALL patients on maintenance can enhance treatment outcomes.

中文翻译：

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急性淋巴细胞白血病患者维持治疗的贫血概况和补充微量营养素的影响。

背景技术贫血是急性淋巴细胞白血病（ALL）患者在诊断或长期治疗过程中发病的常见发现和重要病因。我们研究了维持治疗下所有患者的贫血状况，并评估了特定的微量营养素作为该贫血的原因。患者与方法招募了所有接受维持治疗且≥2级贫血的患者进行研究。进行了血清铁，叶酸和维生素B12的研究，以发现微量营养素缺乏症，并在发现不足的情况下开始补充特定成分。3个月后研究毒性，贫血改善，微量营养素水平和疾病结果。结果从2015年3月至2016年9月，发现105例符合纳入标准的所有患者正在接受维持治疗。总体，贫血比例为80％（N = 84）。多数患有正常性贫血性贫血（71％）。18％的人出现大细胞性贫血，而9.5％的人出现小细胞性低铬。在≥2级的贫血患者中（N = 84），有38名患者（45％）患有血清叶酸的生化缺乏症，而7名患者（8％）具有维生素B12缺乏症。没有发现铁缺乏的生化证据。补充微量营养素可改善贫血：3个月时，平均血红蛋白从8.06±1.63显着增加至10.78±1.53（p <0.001）；降低了治疗毒性，降低了发热性中性粒细胞减少症的平均发作次数（p = 0.007），治疗中断时间> 2周（p = 0.002）。与没有贫血的患者（N = 8.36％）相比，有贫血的患者复发（N = 14,64％）明显更高（p = 0.040）。