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Vitamin D Deficiency and Survival in Children after Hematopoietic Stem Cell Transplant
Gregory Wallace1, Sonata Jodele1, Jonathan Howell2
1Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Vitamin D deficiency is common in children undergoing hematopoietic stem cell transplantation (HSCT), persisting post-transplant and impacting survival. Early screening and aggressive supplementation are crucial for pediatric HSCT patients.
Area of Science:
- Pediatric Hematology and Oncology
- Transplantation Immunology
- Nutritional Science
Background:
- Vitamin D plays a vital role in calcium absorption, bone health, and immune modulation.
- Vitamin D deficiency is a concern in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT).
- Previous studies suggest associations between pre-HSCT vitamin D deficiency and adverse outcomes like graft-versus-host disease (GVHD) and mortality.
Purpose of the Study:
- To investigate the prevalence and consequences of vitamin D deficiency in pediatric HSCT recipients.
- To assess vitamin D levels at baseline and 100 days post-transplant.
- To determine the association between vitamin D status and outcomes such as GVHD and overall survival.
Main Methods:
- Prospective enrollment of 134 pediatric HSCT patients.
- Measurement of serum 25-hydroxy (25 OH) vitamin D levels at baseline and 100 days post-transplant.
- Statistical analysis to correlate vitamin D levels with GVHD and overall survival.
Main Results:
- 70% of patients were vitamin D deficient (<30 ng/mL) before HSCT.
- Vitamin D deficiency persisted in 76% of initially deficient patients and developed in 24% of those with normal levels by day 100.
- Severe vitamin D deficiency (<20 ng/mL) at 100 days post-HSCT was associated with decreased overall survival (70% vs. 84.1%).
- Pre-HSCT vitamin D levels were not associated with GVHD, contrary to prior reports.
Conclusions:
- Vitamin D deficiency is highly prevalent in pediatric HSCT recipients, both before and after transplantation.
- Severe vitamin D deficiency at 100 days post-HSCT is linked to reduced overall survival.
- Routine screening for vitamin D deficiency before and at 100 days post-HSCT, along with aggressive supplementation, is recommended for pediatric patients.
Abstract:
Vitamin D has endocrine function as a key regulator of calcium absorption and bone homeostasis and also has intracrine function as an immunomodulator. Vitamin D deficiency before hematopoietic stem cell transplantation (HSCT) has been variably associated with higher risks of graft-versus-host disease (GVHD) and mortality. Children are at particular risk of growth impairment and bony abnormalities in the face of prolonged deficiency. There are few longitudinal studies of vitamin D deficient children receiving HSCT, and the prevalence and consequences of vitamin D deficiency 100 days after transplant has been poorly studied. Serum samples from 134 consecutive HSCT patients prospectively enrolled into an HSCT sample repository were tested for 25-hydroxy (25 OH) vitamin D levels before starting HSCT (baseline) and at 100 days after transplantation. Ninety-four of 134 patients (70%) had a vitamin D level < 30 ng/mL before HSCT, despite supplemental therapy in 16% of subjects. Post-transplant samples were available in 129 patients who survived to day 100 post-transplant. Vitamin D deficiency persisted in 66 of 87 patients (76%) who were already deficient before HSCT. Moreover, 24 patients with normal vitamin D levels before HSCT were vitamin D deficient by day 100. Overall, 68% of patients were vitamin D deficient (<30 ng/mL) at day 100, and one third of these cases had severe vitamin D deficiency (<20 ng/mL). Low vitamin D levels before HSCT were not associated with subsequent acute or chronic GVHD, contrary to some prior reports. However, severe vitamin D deficiency (<20 ng/mL) at 100 days post-HSCT was associated with decreased overall survival after transplantation (P = .044, 1-year rate of overall survival: 70% versus 84.1%). We conclude that all pediatric transplant recipients should be screened for vitamin D deficiency before HSCT and at day 100 post-transplant and that aggressive supplementation is needed to maintain sufficient levels.
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