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Vitamin D is one of the Lymphoma treatments - Dec 2023
Integrative Approaches in the Treatment of Patients Affected by Lymphoma
Curr Oncol Rep. 2023 Dec 7. doi: 10.1007/s11912-023-01476-4
Ilana Levy Yurkovski 1 2 3, Francesca Andreazzoli 4, Eran Ben-Arye 5 6, Samuel Attias 7, Tamar Tadmor 8 5
Table on content
Purpose of review: Lymphoma is the most frequent hematological malignancy with wide disease spectrum of watchful waiting period, active treatment, survivorship, and palliative care. All these steps impose unmet needs in terms of prevention, symptom alleviation, or prognosis. Complementary and integrative medicine (CIM) is widely used by patients with lymphoma to cope with such issues. Here, we describe the different CIM modalities that may be effective and safe for the management of patients with lymphoma.
Recent findings: Low inflammatory diet and ginseng seem effective for lymphoma prevention. Pain and neuropathy may be improved using acupuncture, touch therapy and specific dietary supplements. Nausea/vomiting, fatigue, and insomnia may be relieved by acupuncture, mind-body, touch therapy, and certain dietary supplements. Vitamin D, curcumin, and some traditional medicine herbs may positively impact lymphoma prognosis. Finally, safety issues should be considered especially for the concomitant use of dietary supplements and lymphoma-directed therapies. CIM may be beneficial along the continuum of lymphoma management although safety concerns should be considered when used concomitantly with conventional therapy.
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Vitamin D deficiency has been shown in multiple studies to be associated with poor prognosis in patients with lymphoma at pre-treatment [63* 64], including in Hodgkin lymphoma [65], DLBCL [66], follicular lymphoma [67], and TCL [66]. An observational study has shown that baseline vitamin D deficiency was more common in obese lymphoma patients at diagnosis and did not change one month after initiating lymphoma treatment [68]. Similar data have been found in treated lymphoma patients. For example, an observational study including 111 adults with relapsed/refractory (R/R) DLBCL pre-CAR-T showed that patients with vitamin D insufficient levels (25(OH)-D < 30 ng/mL) had lower response rates, OS and viability of tisagenlecleucel than repleted patients [69*]. Similar results were observed in patients with R/R DLBCL treated with lenalidomide- rituximab-GDP protocol (R2-GDP) [70*]. Following these data, an Italian study evaluated the effects of vitamin D3 (cholecalciferol) supplementation on the prognosis of highgrade BCL patients treated with R-CHOP and found that 25(OH)-D level < 20 ng/mL was an independent negative prognostic factor and that cholecalciferol supplementation improved event-free survival in such patients [71]. The mechanism of action of this phenomenon has been investigated, and in vitro data suggest that vitamin D supplementation may enhance rituximab-mediated cytotoxicity (Fig. 1) [72].
Indeed, vitamin D seems to
- promote apoptosis,
- induce differentiation, and
- inhibit proliferation of lymphoma cells, while
- reducing the production of pro-inflammatory cytokines and
- sensitizing tumor cells to anti-cancer therapy [73].
Moreover, vitamin D seems to have immunomodulator properties according to a human study on patients with DLBCL treated with R2-GDP protocol which showed that vitamin D deficiency was associated with increased level of immune suppressor cells that were depleted in patients with normal levels of vitamin D with better response to treatment [70*].
Finally, an in vitro and xenograft study showed that vitamin D supplementation increased chemosensitivity of Hodgkin lymphoma cells [65]. Vitamin D3 is well-tolerated in patients with lymphoma [73], and following these data, cholecalciferol supplementation should be considered in all lymphoma patients with vitamin D deficiency (Table 1).