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.
Conclusion: These data suggest that folate fortification does not appear to have caused an increase in therapeutic failures in children with ALL.
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