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Association between Vitamin D and Risk for Early and Late Post-Transplant Complications
Rusha Bhandari1, Jemily Malvar2, Amy Sacapano3
1Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
Insights
Vitamin D deficiency is common in pediatric stem cell transplant patients. While not linked to graft-versus-host disease, higher Vitamin D levels correlate with better survival rates after transplant.
Area of Science:
- Pediatric Hematology/Oncology
- Transplantation Immunology
- Nutritional Science
Background:
- Vitamin D deficiency is prevalent in pediatric hematopoietic stem cell transplant (HSCT) patients.
- Vitamin D influences inflammation and has been linked to graft-versus-host disease (GVHD) and survival.
- Limited data exists on Vitamin D's role in immune complications and optimal supplementation during HSCT.
Purpose of the Study:
- To assess the association between Vitamin D status and post-HSCT complications like GVHD and veno-occlusive disease (VOD).
- To evaluate the effectiveness of routine Vitamin D monitoring and supplementation practices in pediatric HSCT.
- To investigate the relationship between Vitamin D levels and overall survival post-HSCT.
Main Methods:
- Retrospective analysis of 314 pediatric HSCT cases (malignant and non-malignant diseases) from 2013-2018.
- Evaluation of Vitamin D levels (VDL) pre-HSCT and one year post-HSCT.
- Correlation of VDL and supplementation with acute GVHD, VOD, and survival outcomes.
Main Results:
- 61% of patients with pre-HSCT VDL measurements had Vitamin D insufficiency.
- Neither pre-HSCT nor follow-up VDL was significantly associated with GVHD or VOD incidence.
- Increased VDL correlated with improved overall survival; each 10-ng/mL rise decreased mortality risk by 28% (P=.01).
- Current supplementation regimens often fail to achieve sufficient post-HSCT VDL.
Conclusions:
- Vitamin D status is linked to all-cause mortality in pediatric HSCT, but not specific comorbidities.
- Standard Vitamin D supplementation protocols may be insufficient for pediatric HSCT patients.
- Further prospective studies are needed to guide evidence-based Vitamin D monitoring and supplementation strategies during HSCT.
Abstract:
Vitamin D (VD) deficiency is a well-described phenomenon in pediatric patients undergoing hematopoietic stem cell transplant (HSCT). VD modulates inflammation, and deficiency pre-HSCT and at day +100 has been associated with graft-versus-host disease (GVHD) and poorer survival. However, a paucity of data has specifically described the association between VD status and immune-mediated complications including GVHD and veno-occlusive disease (VOD). Additionally, data to guide recommendations for VD monitoring and supplementation during HSCT are scarce. Our primary objective was to evaluate the association between VD and post-HSCT complications. The key secondary aim was to evaluate the routine use and efficacy of VD monitoring and supplementation practices. To our knowledge, this is the largest study of its kind in the pediatric population. This retrospective study evaluated VD level (VDL) before and 1 year after HSCT, VD supplementation practices, and their association with acute GVHD, VOD, and survival in pediatric patients who received autologous and allogeneic HSCT for both malignant and nonmalignant diseases from January 2013 to April 2018. Of 314 HSCTs, 43% of patients (n = 136) had VDL measured before HSCT; 61% of this cohort had pre-HSCT VD insufficiency (<30 ng/mL). Neither pre-HSCT nor follow-up VDL was associated with the incidence of GVHD or VOD. Supplementation did not result in significantly different post-HSCT VDL.VDL was correlated with overall survival; every 10-ng/mL increase in VDL was associated with a 28% decreased risk of death (P = .01). Current accepted VD supplementation regimens for pediatric HSCT do not achieve sufficient VDL in most patients after HSCT. VD status was associated with all-cause mortality but not with individual comorbidities; prospective studies are required to establish the connection between VD status, inflammatory-mediated HSCT complications, and potential benefit of VD supplementation before and after HSCT. These studies are needed to inform evidence-based guidelines for monitoring and supplementing VD during HSCT.
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