Benefit of Increased Dietary Antioxidants During Induction Therapy for Pediatric ALL

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In a study reported in the Journal of Clinical Oncology, Ladas et al found that increased dietary intake of antioxidants was associated with reduced risk for bacterial infection and grade ≥ 3 mucositis during induction therapy in pediatric patients with acute lymphoblastic leukemia (ALL).

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Study Details

The study involved prospective evaluation of dietary intake using a food frequency questionnaire among 794 patients aged 1 to 18 years with newly diagnosed ALL enrolled in the Dana-Farber Cancer Institute ALL Consortium protocol 05-001. Potential associations between intake of antioxidants (vitamins A, E, and C; zinc; and carotenoids) during induction therapy and risk of treatment-related bacterial infection and mucositis were assessed.  

Key Findings

A total of 513 participants completed the diagnosis and end-of-induction dietary surveys. Of these, 120 (23%) had a bacterial infection and 22 (4%) had grade ≥ 3 mucositis during induction therapy.

Significantly decreased risk (all P < .05) of bacterial infection was observed with increased intake of β-carotene (odds ratio [OR] = 0.81), carotenoids (OR = 0.81), and vitamin A (OR = 0.73) from diet alone and for α-carotene from both diet and supplements (OR = 0.90).

Significantly decreased risk (all P < .05) of grade ≥ 3 mucositis was observed with increased intake of vitamins A (OR = 0.64) and E (OR = 0.33); zinc (OR = 0.45); and α-carotene (OR = 0.83) from dietary sources alone and for β-carotene (OR = 0.70) and carotenoids (OR = 0.70) from both diet and supplements.

There were no significant associations between antioxidant intake from dietary sources or supplements and minimal residual disease at the end of induction therapy. Analysis of dietary intake of vitamins A, C, E, and zinc at the end of induction showed no significant associations with disease-free survival.

The investigators concluded, “Consumption of antioxidants through dietary intake was associated with reduced rates of infection or mucositis, with no increased risk of relapse or reduced survival. Dietary counseling on a well-balanced diet that includes an array of antioxidants from food sources alone may confer a benefit from infections and mucositis during treatment of childhood ALL.”

Elena J. Ladas, PhD, RD, of Columbia University Medical Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Tamarind Foundation, American Cancer Society, and American Institute for Cancer Research. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.