From the Research
Folate supplementation is crucial for patients undergoing allogeneic stem cell transplantation, and the most recent evidence suggests that it should be provided at a dose of 1 mg daily, starting from the pre-transplant conditioning phase and continuing throughout the post-transplant recovery period, often for at least 3-6 months or as directed by the transplant team. This is because the intensive chemotherapy and radiation used in conditioning regimens damage rapidly dividing cells, including those in the gastrointestinal tract and bone marrow, increasing folate requirements as new cells are produced during recovery 1. Additionally, many immunosuppressive medications used after transplantation, such as methotrexate for graft-versus-host disease prophylaxis, are folate antagonists that can deplete folate stores 2. Folate deficiency can impair hematopoietic recovery, potentially delaying engraftment and immune reconstitution. Patients may also experience poor oral intake and malabsorption after transplantation, further contributing to folate deficiency. Supplementation helps prevent megaloblastic anemia and supports the rapid cell proliferation needed for successful engraftment and recovery of normal hematopoiesis.
Some studies have investigated the role of folate supplementation in allogeneic stem cell transplantation, with a study from 2021 discussing the role of folinic acid in methotrexate-based prophylaxis of graft-versus-host disease following hematopoietic stem cell transplantation 1. Another study from 2006 found that folic acid supplementation during methotrexate immunosuppression is not associated with early toxicity, risk of acute graft-versus-host disease, or relapse following hematopoietic transplantation 3. A more recent study from 2021 highlighted the importance of nutrition after allogeneic hematopoietic stem cell transplantation, with a focus on safe food handling practices and the use of supplements such as vitamin D and vitamin B12 4.
The most recent and highest quality study, however, is from 2021, which discusses the role of folinic acid in methotrexate-based prophylaxis of graft-versus-host disease following hematopoietic stem cell transplantation 1. This study provides the most up-to-date evidence on the use of folate supplementation in allogeneic stem cell transplantation, and its findings support the recommendation for folate supplementation at a dose of 1 mg daily.
Key points to consider when providing folate supplementation to patients undergoing allogeneic stem cell transplantation include:
- Starting supplementation during the pre-transplant conditioning phase
- Continuing supplementation throughout the post-transplant recovery period, often for at least 3-6 months or as directed by the transplant team
- Providing a dose of 1 mg daily
- Monitoring for signs of folate deficiency, such as megaloblastic anemia
- Considering the use of other supplements, such as vitamin D and vitamin B12, as part of a comprehensive nutrition plan.