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In the primary healthcare setting, the most commonly seen causes of vitamin B12 deficiency are related to abnormalities of digestion (atrophic gastritis, achlorhydria or the consequences of gastrectomy) or absorption (autoimmune pernicious anaemia, chronic pancreatitis, Crohns disease, the effect of medications that alter the mucosa of the ileum, or the consequences of surgical resection), and, to a lesser extent, a lack of exogenous supply

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In contrast, the combination of chemoradiotherapy and immunotherapy with Gln metabolism inhibition may yield a more pronounced anti-tumor effect