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Association of Vitamin A and D Deficiencies with Infectious Outcomes in Children Undergoing Intensive Induction
Rhiannon R Penkert1, Bart G Jones1, Li Tang2
1Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN.
Insights
Vitamin D deficiency in children with acute lymphoblastic leukemia (ALL) is linked to increased infectious complications during initial treatment. Vitamin A deficiency showed a reduced risk of sepsis.
Area of Science:
- Pediatric Oncology
- Nutritional Immunology
- Hematology
Background:
- Infectious complications pose a significant risk during induction therapy for pediatric acute lymphoblastic leukemia (ALL).
- Nutritional status, specifically vitamin A and D levels, may influence immune response and infection risk in these patients.
Purpose of the Study:
- To investigate the association between deficiencies in vitamin A and vitamin D at the time of diagnosis and the occurrence of infectious complications during the induction phase of pediatric ALL treatment.
Main Methods:
- A retrospective cohort study was conducted involving 378 children newly diagnosed with ALL between 2007 and 2017.
- Serum levels of vitamin D, vitamin D binding protein, and retinol binding protein (as a surrogate for vitamin A) were measured at diagnosis.
- Cox regression models were used to assess the relationship between vitamin deficiencies and infection-related complications during the 6-week induction period.
Main Results:
- Vitamin A and D deficiencies were prevalent, affecting 43% and 17% of participants, respectively.
- Vitamin D deficiency was significantly associated with an increased risk of febrile neutropenia, clinically documented infections, and likely bacterial infections.
- Conversely, vitamin A deficiency was associated with a decreased risk of sepsis.
Conclusions:
- Vitamin D deficiency at diagnosis is a risk factor for common infectious complications in children undergoing induction therapy for ALL.
- Further research is needed to determine if vitamin D supplementation can reduce infection rates in this vulnerable population.
Objective:
To evaluate the association between deficiency of vitamin A or D at diagnosis of pediatric acute lymphoblastic leukemia (ALL) and subsequent infectious complications during induction therapy.
Study Design:
We conducted an institutional review board-approved, retrospective cohort study of children with newly diagnosed ALL from 2007 to 2017 at St. Jude Children's Research Hospital. We measured vitamin D, vitamin D binding protein, retinol binding protein as a surrogate for vitamin A, and immunoglobulin isotypes in serum obtained at ALL diagnosis, and we assessed the association between vitamin deficiencies or levels and infection-related complications during the 6-week induction phase using Cox regression models.
Results:
Among 378 evaluable participants, vitamin A and D deficiencies were common (43% and 17%, respectively). Vitamin D deficiency was associated with higher risks of febrile neutropenia (adjusted hazard ratio [aHR], 1.7; P = .0072), clinically documented infection (aHR, 1.73; P = .025), and likely bacterial infection (aHR, 1.86; P = .008). Conversely, vitamin A deficiency was associated solely with a lower risk of sepsis (aHR, 0.19; P = .027).
Conclusions:
In this retrospective study, vitamin D deficiency was associated with an increased risk of common infection-related complications during induction therapy for ALL. Additional studies are warranted to evaluate whether vitamin D supplementation could mitigate this effect.
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