Consuming Antioxidants Through Dietary Intake Beneficial for Patients with Childhood ALL

In a study of children with acute lymphoblastic leukemia (ALL) published in the Journal of Clinical Oncology, researchers found that the consumption of antioxidants through dietary intake was correlated with reduced rates of infection or mucositis, with no increased risk of relapse or reduced survival.¹

These results suggest that dietary counseling on a well-balanced diet that includes antioxidants from an array of food sources may aid in protecting patients from infections and mucositis during the treatment of childhood ALL. However, the results did not support any additional benefit of antioxidant supplementation over and above that obtained by dietary intake alone. 

“This is the first study to suggest that a high-quality diet, rather than taking supplements, during ALL treatment may be beneficial in reducing these common toxicities,” Kara Kelly, MD, the Waldemar J. Kaminski Endowed Chair of Pediatrics at Roswell Park and Chair of the Roswell Park Oishei Children’s Cancer and Blood Disorders Program, said in a press release.² “It really backs up what my research team has been promoting: that you can’t get these benefits by just taking a dietary supplement. There are protective components in whole foods that you don’t get when you take a supplement.”

Overall, researchers enrolled 794 children in a prospective clinical trial for the treatment of ALL and prospectively evaluated dietary intake using a food frequency questionnaire. The association between dietary intake of antioxidants and treatment-related toxicities and survival were assessed with the Benjamini-Hochberg false discovery rate (q) and logistic regression and the Kaplan-Meier method, respectively. 

Ultimately, dietary surveys were available for assessment from 614 (77%), and 561 (71%) participants at the time of diagnosis and at the end of induction, respectively. Increased intake of beta carotene, carotenoids, vitamin A, and alpha carotene led to lower risk of infection, while increased consumption of vitamin A, E, zinc, and carotenoids led to a lower risk of developing mucositis.

Notably, of 513 patients who completed the surveys at both time points, 120 (23%) and 87 (16%) experienced a bacterial infection and 22 (4%) and 55 (10%), respectively, experienced mucositis during the induction or postinduction phases of treatment. 

“Increasing intake of antioxidants through self-reported supplementation, within the reported dose ranges, did not confer an enhanced effect on infections or mucositis when compared with antioxidant intake from dietary sources alone, underscoring the potential benefit of a healthy diet during treatment of childhood ALL,” the authors wrote. “Moreover, we found that dietary intake of antioxidants obtained from food and supplements, within the reported dietary intakes, was neither beneficial nor harmful on rates of high-end induction [minimum residual disease; MRD] or [disease-free survival; DFS]. The latter finding is particularly noteworthy in light of the controversy surrounding antioxidant intake from diet and supplements during cancer therapy.”

According to the researchers, for several nutrients, the majority of the study population was below the minimum dietary requirements for age and sex; therefore, they were unable to evaluate the effect of very low or very high intakes on the toxicities for most of the nutrients explored. In addition, the collection of mucositis toxicity was limited to those experiencing grade ≥3 mucositis. Thus, lower grades of mucositis that may have affected quality of life and nutritional status could not be investigated. 

“Future studies are underway to explore underlying mechanisms by which dietary intake may be exerting a benefit on biologic outcomes and treatment-related toxicities in pediatric ALL (ClinicalTrials.gov identifier: NCT03157323),” the authors wrote. 

Moving forward, Kelly also indicated that she is leading a pilot study at Roswell park which is examining a nutrition education intervention to help promote the adoption of a high-quality diet.

This study was part of a larger phase III clinical trial conducted as part of the Dana Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium, which involves 9 facilities in North America. 

References:

1. Ladas EJ, Blongquist TM, Puligandla M, et al. Antioxidants and Treatment-Related Toxicity in Childhood Leukemia: A Report From the DALLT Cohort. J Clin Oncol. doi:10.1200/JCO.19.02555.

2. Diet Rich in Antioxidants Can Reduce Risk of Infection in Pediatric Leukemia Patients [news release]. Baffalo, NY. Published May 1, 2020. newswise.com/articles/eating-diet-rich-in-antioxidants-can-reduce-risk-of-infection-in-pediatric-leukemia-patients. Accessed May 4, 2020.