Reduced Plasma Ascorbic Acid Levels in Recipients of Myeloablative Conditioning &amp; Hematopoietic Cell Transplantation

Rasheed, Mahmood; Simmons, Gary; Fisher, Bernard; Leslie, Kevin; Reed, Jason; Roberts, Catherine; Natarajan, Ramesh; Fowler, Alpha A.; Toor, Amir A.

doi:10.1101/539007

Cited by 3 publications

(13 citation statements)

References 40 publications

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“…The vitamin C concentrations had not quite recovered to baseline values by week four. This confirms earlier reports that showed similar vitamin C profiles in smaller patient cohorts [ 11 , 12 , 13 ]. Despite recovery to near baseline concentrations by week four, these values are still considered inadequate (i.e., <50 µmol/L).…”

Section: Discussionsupporting

confidence: 93%

“…Oral mucositis is a painful and debilitating inflammatory condition that can prevent eating and drinking. Oral mucositis is thought to be initiated by free radical damage that activates an inflammatory response [ 23 ], and preliminary findings indicate an inverse association between vitamin C status and the severity of mucositis [ 13 ]. Supplementation of allogeneic HSCT recipients with vitamin C at doses of 2000 mg/d resulted in saturating vitamin C status (i.e., >70 µmol/L) and was associated with an improvement in graft versus host symptoms of the mucous membranes [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Myeloablative chemotherapy causes oxidative stress, inflammation, and tissue damage, which contribute to common side effects such as gastrointestinal mucositis [ 8 , 9 , 10 ]. Vitamin C concentrations have been shown to drop dramatically following conditioning chemotherapy [ 11 , 12 , 13 ]. These values continued to decline by week two and took at least one month to recover to pre-chemotherapy concentrations [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Vitamin C concentrations have been shown to drop dramatically following conditioning chemotherapy [ 11 , 12 , 13 ]. These values continued to decline by week two and took at least one month to recover to pre-chemotherapy concentrations [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Patients Undergoing Myeloablative Chemotherapy and Hematopoietic Stem Cell Transplantation Exhibit Depleted Vitamin C Status in Association with Febrile Neutropenia

et al. 2020

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Patients undergoing myeloablative chemotherapy and hematopoietic stem cell transplantation (HSCT) experience profound neutropenia and vulnerability to infection. Previous research has indicated that patients with infections have depleted vitamin C status. In this study, we recruited 38 patients with hematopoietic cancer who were undergoing conditioning chemotherapy and HSCT. Blood samples were collected prior to transplantation, at one week, two weeks and four weeks following transplantation. Vitamin C status and biomarkers of inflammation (C-reactive protein) and oxidative stress (protein carbonyls and thiobarbituric acid reactive substances) were assessed in association with febrile neutropenia. The vitamin C status of the study participants decreased from 44 ± 7 µmol/L to 29 ± 5 µmol/L by week one (p = 0.001) and 19 ± 6 µmol/L by week two (p < 0.001), by which time all of the participants had undergone a febrile episode. By week four, vitamin C status had increased to 37 ± 10 µmol/L (p = 0.1). Pre-transplantation, the cohort comprised 19% with hypovitaminosis C (i.e., <23 µmol/L) and 8% with deficiency (i.e., <11 µmol/L). At week one, those with hypovitaminosis C had increased to 38%, and at week two, 72% had hypovitaminosis C, and 34% had outright deficiency. C-reactive protein concentrations increased from 3.5 ± 1.8 mg/L to 20 ± 11 mg/L at week one (p = 0.002), and 119 ± 25 mg/L at week two (p < 0.001), corresponding to the development of febrile neutropenia in the patients. By week four, these values had dropped to 17 ± 8 mg/L (p < 0.001). There was a significant inverse correlation between C-reactive protein concentrations and vitamin C status (r = −0.424, p < 0.001). Lipid oxidation (thiobarbituric acid reactive substances (TBARS)) increased significantly from 2.0 ± 0.3 µmol/L at baseline to 3.3 ± 0.6 µmol/L by week one (p < 0.001), and remained elevated at week two (p = 0.003), returning to baseline concentrations by week four (p = 0.3). Overall, the lowest mean vitamin C values (recorded at week two) corresponded with the highest mean C-reactive protein values and lowest mean neutrophil counts. Thus, depleted vitamin C status in the HSCT patients coincides with febrile neutropenia and elevated inflammation and oxidative stress.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patients Undergoing Myeloablative Chemotherapy and Hematopoietic Stem Cell Transplantation Exhibit Depleted Vitamin C Status in Association with Febrile Neutropenia

et al. 2020

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“…5 9 10 Additionally, ascorbic acid deficiency has been documented in other clinical conditions associated with inflammation and critical illness, such as hematopoietic stem cell transplantation and SARS-CoV-2. 11 12 Although ascorbic acid supplementation in critically ill adults has produced mixed results on mortality, they have shown decreased need for vasopressors and mechanical ventilation. 13 14 15 16 Similarly, combination therapy of ascorbic acid with corticosteroids and thiamine has demonstrated improved organ dysfunction and mortality in septic patients.…”

Section: Introductionmentioning

confidence: 99%

Plasma Ascorbic Acid Levels in Critically Ill Pediatric Patients

Choi

Basu

Levine

et al. 2022

J Pediatr Intensive Care

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Ascorbic acid, or vitamin C, is a physiological antioxidant that has been found to be deficient in critically ill adults with sepsis and acute respiratory distress system. In adults, ascorbic acid supplementation has been shown to reduce the need for vasopressors and mechanical ventilation. This study aimed to describe the prevalence of ascorbic acid deficiency in critically ill pediatric patients. This prospective, single-centered study analyzed 34 patients aged 1 month to 18 years old with septic shock and/or acute respiratory failure requiring mechanical ventilation in a quaternary, urban, pediatric intensive care unit. Plasma ascorbic acid levels were measured by high-performance liquid chromatography within 24 hours of meeting eligibility criteria. The median level was 23.34 µM (IQR [11.45, 39.14]). Twenty-three patients had repeat samples that were collected 3 to 5 days later. The median for repeat samples was higher at 42.41 µM (IQR [13.08, 62.43]). Patients who were enterally fed had significantly higher levels than those who were not (62.4 ± 7.7 µM vs. 32.4 ± 7.1 µM; p = 0.03). Ascorbic acid levels vary widely among critically ill children with septic shock and/or respiratory failure requiring mechanical ventilation, but one-half of our patients had deficient levels that are typically seen in scurvy. Further studies are warranted to investigate the significance of low levels as well as the impact of normalizing levels through nutritional support.

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Vitamin requirements during stem cell transplantation: a systematic review

Segon

Lam

Chan

et al. 2022

Support Care Cancer

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Patients undergoing stem cell transplantation (SCT) are at high risk of malnutrition during the acute post-transplantation period. This systematic review aimed to collate and analyse the evidence for vitamin requirements post-SCT. A systematic search of five databases was conducted to include studies published until March 2021. The review utilised the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) framework. Inclusion criteria consisted of adults undergoing SCT who received vitamin supplementation or had their vitamin levels monitored up to 100 days post-SCT. Studies with paediatric patients or those that looked at vitamin derivates such as folinic acid were excluded. Main outcomes included vitamin deficiency and relevant clinical outcomes. Eleven studies (n = 11) were eligible for inclusion with five rated as neutral quality and six as positive quality. Five studies focused on allogenic SCT, two on autologous SCT and the remaining included a mix of both. Eight studies monitored vitamins levels post-SCT, and seven studies provided vitamin supplementation. Three studies (one provided supplementation) found a high prevalence of vitamin D deficiency (23–60%) prior to SCT. Findings indicate an unclear association between vitamin deficiency and post-SCT complications including acute graft-versus-host-disease, oral mucositis, and mortality. The GRADE certainty of evidence across these outcomes was low or very low. It is unclear if supplementation is needed during SCT, though assessing vitamin D levels prior to transplant should be considered. Further large observational studies or randomised control trials are required to establish vitamin requirements and guide supplementation protocols during SCT.

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Reduced Plasma Ascorbic Acid Levels in Recipients of Myeloablative Conditioning & Hematopoietic Cell Transplantation

Cited by 3 publications

References 40 publications

Patients Undergoing Myeloablative Chemotherapy and Hematopoietic Stem Cell Transplantation Exhibit Depleted Vitamin C Status in Association with Febrile Neutropenia

Patients Undergoing Myeloablative Chemotherapy and Hematopoietic Stem Cell Transplantation Exhibit Depleted Vitamin C Status in Association with Febrile Neutropenia

Plasma Ascorbic Acid Levels in Critically Ill Pediatric Patients

Vitamin requirements during stem cell transplantation: a systematic review

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