Effect of vitamin D treatment in chronic GVHD

Silva, F; Pérez-Simón, Josè Antonio; Velázquez, T; Sánchez‐Guijo, Fermín; Villanueva-Gomez, F; Vázquez, Lourdes; Cañizo, Consuelo del; Caballero, Dolores; Miguel, Jesús F. San

doi:10.1038/bmt.2010.317

Cited by 23 publications

(21 citation statements)

References 11 publications

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“…The steroid hormone vitamin D is known to affect immunologic processes [18], and, more recently, novel mechanisms of action have been uncovered [3,4,18,19]. A few studies suggest that sufficient vitamin D levels may benefit patients undergoing HSCT [6,7,9]. In the present study we followed 123 pediatric patients for up to 8 years post-HSCT and correlated their baseline vitamin D status with a number of clinical outcomes.…”

Section: Discussionmentioning

confidence: 96%

“…Previous data suggest that vitamin D might prevent graft-versus-host disease (GVHD). Vitamin D exposure also resulted in immature dendritic cell populations with bias toward tolerizing rather than stimulatory T-lymphocyte populations, which could provide a possible mechanism for its beneficial effects against GVHD [6,7]. Humans attain vitamin D mainly from exposure to sunlight and to a lesser extent from dietary sources.…”

Section: Introductionmentioning

confidence: 99%

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Vitamin D Levels Affect Outcome in Pediatric Hematopoietic Stem Cell Transplantation

Hansson

Norlin

Omazic

et al. 2014

Biology of Blood and Marrow Transplantation

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The importance of vitamin D in immunologic processes has recently emerged, but whether it has any impact on the course of allogeneic hematopoietic stem cell transplantation (HSCT) has not been determined. Reports indicate that HSCT recipients, particularly children, often suffer from vitamin D deficiency. This study investigated the role of vitamin D in 123 children undergoing HSCT from 2004 to 2011. Vitamin D (ie, serum calcidiol) was analyzed in collected cryostored samples. Patients were grouped according to pre-HSCT calcidiol level: insufficient (<50 nm/L, n = 38) and sufficient (≥50 nm/L, n = 85). Older children who underwent transplants from January through June and children of Middle Eastern or African origin were more commonly found in the insufficient group. Acute grades II to IV graft-versus-host disease occurred more frequently in the vitamin D sufficient group (47% versus 30%, P = .05), whereas no difference was demonstrated for chronic graft-versus-host disease. The neutrophil granulocytes rose significantly faster in the vitamin D sufficient group. No difference in lymphocyte counts, immunoglobulin levels, or infectious disease burden during the first year post-HSCT were observed. Among children with malignancies, overall survival was significantly better in the sufficient group (87% versus 50%, P = .01). In addition, rejection (0% versus 11%, P = .06) and relapse (4% versus 33%, P = .03) rates were lower in patients with sufficient vitamin D levels. To conclude, vitamin D may have an important impact on the outcome of pediatric HSCT, particularly in patients with malignant disease. Further studies investigating whether vitamin D acts as an immunomodulator or is merely a surrogate marker of patient health or nutritional status are warranted.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Vitamin D Levels Affect Outcome in Pediatric Hematopoietic Stem Cell Transplantation

Hansson

Norlin

Omazic

et al. 2014

Biology of Blood and Marrow Transplantation

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“…Previous studies have shown conflicting results; although one study on 53 adult patients suggests an association between vitamin D levels and cGvHD incidence, 6 others have reported better outcomes in established cGvHD after vitamin D supplementation. 27 A recent study on 123 pediatric patients failed to show an association between pre-transplantation vitamin D levels and cGvHD incidence. 28 The general incidence of cGvHD in the pediatric study was very low, only 14%, which could explain why no association was seen.…”

Section: Discussionmentioning

confidence: 99%

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Bahr

Blennow

Alm

et al. 2015

Bone Marrow Transplant

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Vitamin D has emerged as a central player in the immune system, with its deficiency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were deficient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identified as a significant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-deficient patients. In addition, we found a significant correlation between vitamin D deficiency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufficient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These findings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of vitamin D supplementation are therefore needed.

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“…Importantly, in this publication, 50% of patients who received vitamin D for osteopenia or osteoporosis following allogeneic transplantation were off immunosuppression at 6 months, compared with 20% in patients who did not receive vitamin D. 50 The effect of vitamin D supplementation on transplant outcome is a critical question that requires evaluation in a prospective clinical trial.…”

Section: Discussionmentioning

confidence: 99%

Low levels of 25-hydroxyvitamin D before allogeneic hematopoietic SCT correlate with the development of chronic GVHD

Glotzbecker

Aldridge

et al. 2012

Bone Marrow Transplant

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Vitamin D, a hormone involved in bone and calcium homeostasis, has been shown to have potent immunomodulatory effects. We performed a retrospective cohort analysis to evaluate whether monohydroxyvitamin D levels before allogeneic hematopoietic SCT (HSCT) correlate with the risk of GVHD. Fifty-three patients who underwent myeloablative HSCT were studied. Vitamin D levels were measured in serum samples obtained before HSCT. The median 25-hydroxyvitamin vitamin D level was 21.9 ng/mL (7.8-45.7). The cumulative incidence (CI) of grades II-IV acute GVHD at 100 days was 53.1% in patients with vitamin Do25, versus 33.3% in patients with vitamin DX25 ng/mL (P ¼ 0.13). The CI of chronic GVHD (cGVHD) at 2 years in patients with vitamin Do25 was 63.8%, compared with 23.8% in patients with vitamin DX25 ng/mL (P ¼ 0.009). Similarly, the 2 year CI of extensive cGVHD was significantly greater in patients with vitamin Do25 compared with those with vitamin DX25 ng/mL (54.5% versus 14.3%, P ¼ 0.005). In a multivariable competing risk model, low pre-transplant vitamin D levels remained a significant factor associated with cGVHD (hazard ratio ¼ 5.26, P ¼ 0.02). Our results demonstrate that vitamin D deficiency before HSCT is associated with an increased risk of cGVHD. (2013) 48, 593-597; doi:10.1038/bmt.2012 published online 24 September 2012 Keywords: Vitamin D; GVHD; hematopoietic SCT INTRODUCTION GVHD remains a significant cause of morbidity and mortality following allogeneic HSCT. Despite standard immune-suppression with a calcineurin inhibitor and MTX, grade II-IV acute GVHD rates range from 20-50% and chronic GVHD from 40-50% after BMT. Bone Marrow Transplantation

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Effect of vitamin D treatment in chronic GVHD

Cited by 23 publications

References 11 publications

Vitamin D Levels Affect Outcome in Pediatric Hematopoietic Stem Cell Transplantation

Vitamin D Levels Affect Outcome in Pediatric Hematopoietic Stem Cell Transplantation

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

Low levels of 25-hydroxyvitamin D before allogeneic hematopoietic SCT correlate with the development of chronic GVHD

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