Does vitamin A prevent high-dose-methotrexate-induced D-xylose malabsorption in children with cancer?

Support Care Cancer. 2004 Apr;12(4):263-7. doi: 10.1007/s00520-004-0591-8. Epub 2004 Feb 6.


Purpose: Our aim was to explore whether vitamin A has protective effect on high-dose-methotrexate (HDMTX)-induced intestinal D-xylose malabsorption in children with leukemia and lymphoma.

Patients and methods: We performed a prospective randomized un-blinded study of vitamin A in 35 children with leukemia and lymphoma who were planned to receive HDMTX 3 g/m(2) and 5 g/m(2), respectively. Twenty-two patients (group 1) received a single dose of 180,000 IU a day before HDMTX was given, and 13 (group 2) received only HDMTX. The vitamin A group received the vitamin only once. Oral D-xylose absorption tests before and 7 days after HDMTX were carried out to evaluate intestinal absorption. Retinol-binding protein (RBP) levels prior to therapy were also measured for vitamin A status.

Results: Although we observed no difference of HDMTX-induced toxicity, including hematological, dermatological, systemic, and other toxicities, between groups, the D-xylose absorption test was significantly better in-group 1 ( p=0.030). Absorption was decreased in five of 22 patients (23%) who received vitamin A comparing to eight of 13 (62%) who received only HDMTX ( p=0.033). RBP levels were lower than normal in 13 of 22 patients in-group 1 and nine of 13 in group 2. In patients whose RBP levels were lower than normal, HDMTX-induced toxicity was lower in the group 1 than group 2 but not statistically significant. No sign of vitamin A toxicity was observed throughout the study.

Conclusion: The administration of vitamin A before HDMTX may protect against drug-induced D-xylose malabsorption in children with cancer. Further studies are apparently needed to clarify the full benefits of vitamin A in preventing HDMTX-induced mucosal damage.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Intestinal Absorption / drug effects
  • Intestinal Mucosa / drug effects
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Malabsorption Syndromes / chemically induced*
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Prospective Studies
  • Protective Agents / administration & dosage
  • Protective Agents / therapeutic use*
  • Retinol-Binding Proteins / analysis
  • Vitamin A / administration & dosage
  • Vitamin A / therapeutic use*
  • Xylose / metabolism*


  • Antimetabolites, Antineoplastic
  • Protective Agents
  • Retinol-Binding Proteins
  • Vitamin A
  • Xylose
  • Methotrexate