Vitamin D deficiency in children and adolescents submitted to hematopoietic stem cell transplantation

Abstract

BackgroundSub-optimal levels of vitamin D have been found to be highly prevalent in all age groups, with epidemiologic studies demonstrating a link between vitamin D deficiency and disease susceptibility, such as infection and cancer, and mortality rates. In adult transplant patients, it has been suggested that the immunomodulatory properties of vitamin D may have an important role in the prevention and treatment of graft-versus-host disease.ObjectiveThe objective of this study was to assess serum 25-hydroxyvitamin D levels of children and adolescents submitted to allogeneic hematopoietic stem cell transplantation. Methods: Serum 25-hydroxyvitamin D levels of 66 patients, aged 4-20 years, were assessed at three stages: before hospitalization for hematopoietic stem cell transplantation and at 30 and 180 days after hematopoietic stem cell transplantation. The control group consisted of 25 healthy children.ResultsAt the pre-hematopoietic stem cell transplantation stage, patients had lower levels of 25-hydroxyvitamin D compared to controls (25.7 ± 12.3 ng/mL vs. 31.9 ± 9.9 ng/mL; p-value = 0.01), and a higher prevalence of 25-hydroxyvitamin D deficiency (32% vs. 8%; p-value = 0.01). Prevalence increased significantly after hematopoietic stem cell transplantation (p-value = 0.01) with half of the patients having vitamin D deficiency at 180 days after transplantation. At this stage, mean serum 25-hydroxyvitamin D levels were 20.9 ± 10.9 ng/mL, a significant decline in relation to baseline (p-value = 0.01). No correlation was found between 25-hydroxyvitamin D levels and vitamin D intake, graft-versus-host disease, corticoid use or survival rates.ConclusionLow levels of 25-hydroxyvitamin D were detected even before hematopoietic stem cell transplantation and were significantly lower at 180 days after hematopoietic stem cell transplantation, thus recommending vitamin D supplementation for children and adolescents submitted to hematopoietic stem cell transplantation.

1,25-dihydroxyvitamin-D3 but not the clinically applied marker 25-hydroxyvitamin-D3 predicts survival after stem cell transplantation

“…In four studies early low 25hydroxyvitamin-D3 levels were associated with increased overall mortality [4,5,18,25]. In contrast, no significant impact of early 25-hydroxyvitamin-D3 serum levels on overall survival was described in four studies [3,7,23,24]. In line, also in our study low peritransplant 25hydroxyvitamin-D3 levels were no risk factor for mortality.…”

Insights Into the Role of Vitamin D as a Biomarker in Stem Cell Transplantation

“…The high incidence of vitamin D deficiency in allogeneic HSCT patients, alongside the current controversy (9,11,84,114,115,132,141), emphasizes the need for further studies on the impact of vitamin D deficiency and VDR gene polymorphisms on clinical outcomes to define its role as a biomarker in this setting.…”

“…Awareness of the immune-regulatory properties of vitamin D and its potential impact on immune reconstitution post-HSCT and GvHD were acknowledged by a minority of centers (24 and 17%, respectively), being the main reason to commence on vitamin D therapy the maintenance of calcium metabolism and bone health (62%). Since the optimal dose of vitamin D replacement has not been standardized yet in the HSCT population and this differs between pediatric and adult population (ranging from 1,000 IU per day to 600,000 IU per week) (11,64,141,(151)(152)(153)(154)(155), dosage prescribed by HSCT clinicians varied greatly across centers (14).…”

Hematopoietic Stem Cell Transplantation and Current Nutritional Approaches: Review

“…[30][31][32] Yapılan bir çalışmada, nakil sonrası 180. günde katılımcıların %48'inde D vitamini eksikliğine rastlanmıştır. 33 Serum kalsidiol değerlerinin araştırıldığı KHN olmuş 123 çocuk ile yürütülen çalışmada, serum kalsidiol değeri yeterli olan grupta, yeterli olmayan gruba göre; nötrofil granülleşmesi daha hızlı (p<0,05), nakledilen doku reddi ve nüks riski daha düşük, sağkalım oranı daha yüksek bulunmuştur. 22 Ek olarak, GVH hastalığından korunma ve tedavide de D vitamininin önemli bir rolü olabileceği belirtilmektedir.…”