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Vitamin D has no impact on outcomes after HSCT in children-A retrospective study
Rajinder P S Bajwa1, Kimberly Taylor1, Amanda Hoyt1
1Division of Pediatric Hem/Onc/BMT, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Vitamin D deficiency (VDD) or insufficiency (VDI) did not impact outcomes in pediatric patients undergoing allogeneic hematopoietic stem cell transplant (HSCT). Further multicenter studies are needed to confirm these findings in pediatric HSCT. Keywords: Vitamin D, HSCT, pediatric, outcomes.
Area of Science:
- Immunology
- Pediatric Hematology/Oncology
- Endocrinology
Background:
- Vitamin D plays a crucial role in bone metabolism and immune function.
- Low vitamin D levels may negatively affect immune-mediated processes.
- Pediatric studies on vitamin D and allogeneic HSCT are predominantly single-center.
Purpose of the Study:
- To investigate the association between vitamin D levels and outcomes in pediatric patients undergoing allogeneic HSCT.
- To compare transplant characteristics and outcomes in children with vitamin D deficiency/insufficiency versus normal levels.
Main Methods:
- Retrospective analysis of 233 pediatric patients undergoing allogeneic HSCT across 5 US centers.
- Vitamin D levels categorized as deficiency (<20 ng/ml) or insufficiency (21-30 ng/ml).
- Comparison of engraftment, infections, hospital stay, graft failure, GvHD, survival, and relapse rates.
Main Results:
- Mean vitamin D levels were suggestive of insufficiency pre-HSCT and early post-HSCT, normalizing later.
- No statistically significant differences were observed in neutrophil/platelet engraftment between groups.
- Infections, GvHD, survival, and relapse rates were similar across vitamin D level groups.
Conclusions:
- Vitamin D insufficiency or deficiency does not appear to affect key transplant variables in pediatric allogeneic HSCT.
- Larger, multicenter prospective studies are warranted to further elucidate the role of vitamin D in HSCT outcomes.
Abstract:
Vitamin D not only plays an important role in bone metabolism but is also involved in multiple immune-mediated processes in the body which may be adversely affected in those with low levels. Most pediatric studies evaluating the association of vitamin D in patients undergoing allogeneic HSCT are single-center studies. We present the results of retrospective study at 5 centers across the United States in pediatric patients undergoing allogeneic HSCT. (VDD) and (VDI) were defined by vitamin D levels of <20 ng/ml and 21-30 ng/ml, respectively. The mean vitamin D levels pre-HSCT, day +30, and +100 were suggestive of VDI, but normalized thereafter. We compared the transplant characteristics and outcomes in 233 patients with VDD and VDI and those with normal levels and found no statistical difference in neutrophil or platelet engraftment, infections (viral, bacterial, or fungal) post-HSCT, length of hospital stay during HSCT, graft failure, acute or chronic GvHD, survival at day +100 and 1 year, or relapse of primary malignancy. We conclude that VDI or deficiency does not affect any of the common transplant variables after allogeneic HSCT in children. There is a need of a large multicenter prospective study to evaluate its role further.
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