Vitamin D Deficiency in Pediatric Hematopoietic Stem Cell Transplantation Patients Despite Both Standard and Aggressive Supplementation.
Biol Blood Marrow Transplant. 2016 Jul;22(7):1271-1274. doi: 10.1016/j.bbmt.2016.03.026. Epub 2016 Apr 1.
Wallace G1, Jodele S2, Myers KC2, Dandoy CE2, El-Bietar J2, Nelson A2, Taggart CB2, Daniels P2, Lane A2, Howell J3, Teusink-Cross A4, Davies SM2.
Vitamin D levels need to restored as quickly as possible for transplant and other emergency situations
A steady dose Vitamin D (such as 200 IU/kg) will restore vitamin D levels in months.
It would be far better to benefit from Vitamin D for stem cell translant in weeks or even days
- Bone marrow transplant – like other traumas – lowers vitamin D levels – July 2011
- Stem Cell Transplants consume vitamin D – July 2011
- Vitamin D helps organ transplant
- If you are getting a lung transplant you must have vitamin D - April 2012
Overview Loading of vitamin D contains the following
If a person is, or is suspected to be, very vitamin D deficient a loading dose is typically given
- Loading = repletion = quick replacement (previously known as Stoss)
- Loading doses range in size from 100,000 IU to 1,000,000 IU of Vitamin D3
- The size of the loading dose is a function of body weight - see below
Unfortunately, some doctors persist in using Vitamin D2 instead of D3
- Loading may be done as quickly as a single day, to as slowly as 3 months.
It appears that spreading the loading dose over 4-20 days is a good compromise
- Loading is typically oral, but sometimes by injection (I.M,)
- The loading dose persists in the body for about 3 months
The loading dose should be followed up with continuing maintenance
Unfortunately, many doctors fail to follow-up with the maintenance dosing.
- As about 1 in 300 people have some form of mild allergic reaction to vitamin D supplements,
it appears prudent to test with a small amount of vitamin D before giving a loading dose
- The causes of a mild allergic reaction appear to be: (in order of occurance)
1) lack of magnesium - which can be easily added
2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
- Clinical Trials: Transplant and Vitamin D 60 listed as of Jan 2018
We recently reported that more than 70% of pediatric and young adult patients had a vitamin D (VD) deficiency at the time of their hematopoietic stem cell transplantation (HSCT). Moreover, VD deficiency was associated with inferior survival at 100 days after transplantation. The goal of the present study was to evaluate the VD requirements needed to maintain an optimal VD level (30 to 60 ng/mL) during the first 3 months after transplantation using real-time VD monitoring and personalized VD supplementation.
We examined 2 cohorts in this study:
- cohort 1, the "preintervention" cohort (n = 35), who were treated according to National Kidney Foundation guidelines for VD therapy, and
- cohort 2, the "intervention" cohort (n = 25) who were treated with high-dose VD with an aggressive dosage increase in those who remained VD-insufficient.
Results from cohort 1 showed that despite aggressive monitoring and VD supplementation, therapeutic vitamin D levels were difficult to achieve and maintain in HSCT recipients during the early post-transplantation period.
Only 43% of cohort 1 achieved a therapeutic VD level, leading to our intervention in cohort 2. Outcomes improved in cohort 2, but still only 64% of cohort 2 patients achieved a therapeutic VD level despite receiving >200 IU/kg/day of VD enterally. The median VD level in patients who did achieve sufficient levels was 40 ng/mL, with only 1 patient in each cohort achieving a supratherapeutic but nontoxic level. These data indicate that standard guidelines for VD replacement are inadequate in HSCT recipients, and further work is needed to define more appropriate dosing in this clinical setting.
PMID: 27044905 PMCID: PMC5684702 DOI: 10.1016/j.bbmt.2016.03.026