Stem cell transplant (HSCT). death 28 percent less likely for each 10ng higher vitamin D level – Oct 2019

Association Between Vitamin D and Risk for Early and Late Post-Transplant Complications

Biology of Blood and Marrow Transplantation, https://doi.org/10.1016/j.bbmt.2019.10.011
Bhandari R1, Malvar J2, Sacapano A3, Aguayo-Hiraldo P4, Jodele S5, Orgel E4.

• 1 Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California; Keck School of Medicine of University of Southern California, Los Angeles, California. Electronic address: rbhandari at chla.usc.edu.
• 2 Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California.
• 3 Clinical Nutritional and Lactation Services, Children's Hospital of Los Angeles, Los Angeles, California.
• 4 Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California; Keck School of Medicine of University of Southern California, Los Angeles, California.
• 5 Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, California; Keck School of Medicine of University of Southern California, Los Angeles, California; Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Background
Vitamin D (VD) deficiency is a well-described phenomenon in pediatric patients undergoing hematopoietic stem cell transplantation (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 have 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.

Objectives
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.

Methods
This retrospective study evaluated VD level (VDL) before and for one year following 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 non-malignant diseases from January 2013 to April 2018.

Results
Of 314 HSCTs, 43% (n=136) had VDL measured prior to HSCT; 61% of this cohort had pre-HSCT VD insufficiency (<30ng/mL). Neither pre-HSCT nor follow-up VDL were 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 10ng/mL increase in VDL was associated with a 28% decreased risk of death (p=0.01).

Conclusions
Current accepted VD supplementation regimens for pediatric HSCT do not achieve sufficient VDL in most patients following HSCT. VD status was associated with all-cause mortality but not individual comorbidities; prospective studies are required to establish the connection between VD status, inflammatory-mediated HSCT complications, and potential benefit of VD supplementation prior to and following HSCT. These studies are needed to inform evidence-based guidelines for monitoring and supplementing VD during HSCT.