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

Glotzbecker, Brett; Ho, Vincent T.; Aldridge, Julie; Kim, H T; Horowitz, Gary L.; Ritz, Jérôme; Soiffer, Robert J.; Avigan, David; Rosenblatt, Jacalyn

doi:10.1038/bmt.2012.177

Cited by 56 publications

(77 citation statements)

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“…This might be because IDO activity in serum by circulating monocytes 26 overshadows DC activity in the tissues, but more studies focusing on vitamin D effects in vivo are needed. 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.…”

Section: Discussionmentioning

confidence: 77%

“…[2][3][4] A vitamin D-enriched milieu maintains an immature DC phenotype associated with decreased ability to stimulate alloreactive T cells in MLCs. 5 Vitamin D deficiency has been associated with an increased incidence of chronic GvHD, 6 and supplementation with vitamin D to induce a tolerogenic DC population has been suggested for prevention of GvHD. 7 One mechanism for this maintenance of an immature DC population has been shown to be the upregulation of indoleamine 2,3-dioxygenase (IDO), 8 an enzyme converting tryptophan to kynurenine and a central feature in tolerizing DCs.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

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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“…Este alto porcentaje es concordante con la literatura internacional que muestra una frecuencia de insuficiencia de vitamina D entre 70 y 100% en pacientes sometidos a TPH 7,16,17 . Este hecho es de especial relevancia clínica considerando que, como ya fue mencionado, datos recientemente publicados muestran que el déficit de vitamina D puede impactar negativamente en la respuesta a tratamiento, así como en la sobrevida en algunas neoplasias hematológicas [8][9][10][11][12] . Encontramos también una alta frecuencia de hiperparatiroidismo secundario que en parte puede ser explicado por el déficit de vitamina D, pero deben considerarse otros factores tales como alteraciones de absorción intestinal de calcio, alteraciones de hidroxilación renal de la vitamina D, procesos inflamatorios sistémicos, entre otros.…”

Section: Discussionunclassified

“…Concordante a lo anterior Wallace et al encontró que el déficit de Vitamina D (< 20 ng/mL) 100 días post TPH en niños se asociaba a disminución significativa en la sobrevida global 10 . Glotzbecker et al demostró en pacientes evaluados pre TPH alogénico, que aquellos con déficit de vitamina D (< 25 ng/mL) tenían incidencia acumulada de GVHD crónico a dos años significativamente mayor que aquellos con niveles sobre 25 ng/mL 11 . Por último con respecto a Vitamina D y neoplasias hematológicas Kelly et al reportó una asociación inversa entre el riesgo de Linfoma no Hodgkin y el tiempo de exposición solar en pacientes de 13 a 21 años, presuntamente mediada por cambios en el metabolismo de vitamina D y su receptor 12 .…”

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Salud ósea en pacientes sometidos a trasplante de precursores hematopoyéticos: un nuevo problema a considerar

et al. 2016

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“…Patients who are at increased risk of infection, such as those undergoing chemotherapy or with altered immune function (such as transplant patients), might benefit from rapid normalization of vitamin D status. 29,30 These clinical benefits are hypothetical at present but can be tested using this supplementation method.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Protocol Demonstrating Rapid, Safe, and Effective Treatment of Vitamin D Deficiency

Cantor

2014

Integr Cancer Ther

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ArticleVitamin D deficiency and insufficiency are extremely prevalent. [1][2][3][4] As measured by 25-hydroxy vitamin D (25-OH D), deficiency is defined as levels <15 ng/mL (if measured as mmol/L multiply by 2.5). Insufficiency is defined as levels <30 ng/mL. The known and hypothesized clinical consequences of this are significant because vitamin D has important effects on a wide range of physiological processes. It has long been known that inadequate vitamin D status has deleterious clinical effects on bone health. A large and growing body of studies have suggested that vitamin D has additional important effects on numerous other biologic processes, such as cell differentiation and immune system functioning. 2,3 Studies have shown that individuals with higher 25-OH D levels have a significantly lower incidence of many malignancies, autoimmune diseases, and cardiovascular diseases compared with those with less-adequate 25-OH D status.5-9 From a related, but different perspective, intriguing studies have shown that when baseline vitamin D levels are measured in patients with numerous malignancies, including lung, colon and breast, before their oncological treatment begins, those patients with higher 25-OH D levels have improved outcomes compared with patients with the same malignancies but with lower levels of baseline 25-OH D. [10][11][12][13][14] This article describes a protocol that is able to safely normalize low vitamin D levels within 1 to 2 weeks with a high degree of predictability. The use of this protocol will allow the testing of the following hypothesis: if patients with various malignancies have their vitamin D deficiency corrected before formal oncological treatment begins, they will have an improved prognosis compared with patients who remain vitamin D deficient while receiving oncological treatment.Most physicians and labs consider levels of 25-OH D ≥30 ng/mL (75 mmol/L) or higher to be normal, though some recent studies have questioned if normal is as low as 20 ng/mL. Most notable in this latter regard is the highly publicized report from the Institute of Medicine. 15 In the context of the present article, some clarifying comments about this report are in order. The authors of the report from the Institute of Medicine considered that effects of vitamin D, besides the well-known effects on bone health, were not sufficiently proven; therefore, their conclusion that normal levels should be considered to be as low as 20 ng/mL were only relevant for bone health. Suggestive extraskeletal effects of vitamin D were expressly excluded from their report and recommendations. In other words, potential effects of vitamin D status in malignancies, both regarding prevention and potential treatment, as will be discussed in this article, had no place in their report. AbstractVitamin D status has importance in the prevention and treatment of many malignancies. Patients with breast, colon, and lung malignancies with higher vitamin D status at the onset of treatment have an improved prognosis compared with those p...

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

Cited by 56 publications

References 50 publications

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

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

Salud ósea en pacientes sometidos a trasplante de precursores hematopoyéticos: un nuevo problema a considerar

A Clinical Protocol Demonstrating Rapid, Safe, and Effective Treatment of Vitamin D Deficiency

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