No Effect of Vitamin C Administration on Neutrophil Recovery in Autologous Stem Cell Transplantation for Myeloma or Lymphoma: A Blinded, Randomized Placebo-Controlled Trial

Abstract

Vitamin C is an important micronutrient for various immune cells. It increases phagocytic cell function and is necessary for T and natural killer (NK) cell development. Patients in need of an autologous hematopoietic stem cell transplantation (HSCT) are often vitamin C-depleted. We therefore hypothesized that vitamin C supplementation could improve immune recovery in autologous HSCT patients. This blinded, placebo-controlled trial included 44 patients randomized to receive vitamin C or a placebo. The following outcome measures used were clinical and immunological parameters, among others: time to neutrophil recovery, serum, and intracellular vitamin C values. Twenty-one patients received vitamin C, and 23 received a placebo. The time to neutrophil recovery did not differ between the two groups at 11.2 days (p = 0.96). There were no differences in hospitalization time (19.7 vs. 19.1 days, p = 0.80), the incidence of neutropenic fever (57% vs. 78%, p = 0.20), or 3-month overall survival (90.5% vs. 100%, p = 0.13). Bacteremia seemed to occur less in the vitamin C group (10% vs. 35%, p = 0.07). Our study shows no benefit from vitamin C supplementation on neutrophil recovery and hospitalization, despite possible lower rates of bacteremia in the vitamin C group. Therefore, we do not advise vitamin C supplementation in this treatment group.

The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation

“…Overall, VD plays a significant role in haematopoiesis and immunity and might play a vital role in preventing aGvHD in post-HSCT patients [ 99 ]. The use of ascorbate in these patients produces relatively different results [ 104 , 105 , 106 ]. The intestinal flora plays an important role in prognosis, especially in the context of GvHD [ 109 , 111 , 112 , 115 , 120 ].…”

“…It also influences the synthesis of connective tissue-building collagen, corticosteroids, and some neurotransmitters, and is important in iron absorption and haematopoiesis [ 100 , 101 , 102 , 103 ]. Much evidence suggests the involvement of vitamin C in immune enhancement processes [ 104 ]. The human body does not have the capacity to synthesise it on its own—it must be supplied with food [ 101 ].…”

“…No significant difference was observed between the groups in neutrophil recovery time, hospitalisation time, incidence of neutropenic fever or 3-month overall survival. The authors of this study explicitly do not recommend vitamin C supplementation in this treatment group [ 104 ].…”

Conceptualizing an Integrative Multiple Myeloma Care: The Role of Nutrition, Supplements, and Complementary Modalities

“…Despite its importance for the immune cells, it is ineffective in improving bone marrow recovery after ASCT both in MM and lymphoma patients, so its use is not advised in this setting [ 73 ].…”

Reflection of Vitamins and Mineral Deficiency in General Health Condition: Article Review

“…Ascorbic acid is synthesized by most animals and plants; humans and primates, on the other hand, loss gluconolactone oxidase, an enzyme that is necessary for the final step of the production of ascorbate. As a result, these species' daily needs for vitamin C should be met by the food (49).The greatest foods high in vitamin C include beef liver, oranges, lemons, grapefruits, and vegetables. For wound healing and a healthy immunety system, vitamin C is necessary for the process that produces collagen, which fortifies connective tissues.…”