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High Prevalence of Vitamin D Deficiency in Newly Diagnosed Acute Myeloid Leukemia Patients and Its Adverse Outcome - 2017
International Journal of Hematology-Oncology and Stem Cell Research 2017. 11(3):209-216.
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|Complete Remission||61%||92%||0.04 #|
|Disease-free for 6 months||45%||75%||0.06|
|Median days in hospital||45||33||0.04 #|
# = significant difference
- Cancer - Leukemia
- Leukemia and vitamin D – several studies
- Lymphoma, leukemia etc, survival poor if low vitamin D – meta-analysis March 2015
- Bone Cancer which produces abnormal white blood cells t
- “AML is the most common acute leukemia”
- “ . . AML progresses rapidly and is typically fatal within weeks or months if left untreated.”
- “AML is cured in 5–15% over 60 years old. Older people who are not able to withstand intensive chemotherapy have an average survival of 5–10 months.”
- “A lack of normal white blood cell production makes people more susceptible to infections; while the leukemic cells themselves are derived from white blood cell precursors, they have no infection-fighting capacity”
Worse AML survival with age
Fatere Seyedalipour, Ava Mansouri, Mohammad Vaezi, Kheirollah Gholami, Molouk Hadjibabaie, Ardeshir Ghavamzadeh
Background: Although several studies have supported a preventive and therapeutic role of vitamin D (Vit D) for different types of cancers, we face insufficient documentation in acute myeloid leukemia (AML). So, we examined whether the serum calcidiol (25(OH)D) levels at the time of induction therapy have any impact on response and relapse in AML patients.
Subjects and Methods: Blood samples were collected from 65 patients on days 0 and 28th of treatment to evaluate serum concentration of 25(OH)D and its effects on complete remission (CR) achievement, relapse rate and hospitalization length.
Results: Of the 65 patients who were included in the study, 38 were male (58.5%) and 27 were female (41.5%). Median age at the time of treatment was 37 years (range 15-68). 6% of the participants were older than 60 years. In regard to 25(OH)D levels, 81.5% of AML patients were deficient (levels <20 ng/ml). There was a significant difference in CR between patients with sufficient and deficient level of 25(OH)D. Deficient patients had longer length of hospitalization than those with sufficient levels. Also Vitamin D deficient patients had higher serum ALP levels. The mean level of 25(OH)D on treatment day 28th in our study was significantly lower than the baseline value.
Conclusion: The results of the study showed that serum 25(OH)D levels deficiency was highly prevalent among Iranian AML patients. Furthermore, higher Vit D levels in AML patients were associated with better outcome in these patients.
Exp Hematol. 2017 Jun;50:1-12. doi: 10.1016/j.exphem.2017.01.007. Epub 2017 Feb 4.
Cao H1, Xu Y2, de Necochea-Campion R3, Baylink DJ2, Payne KJ4, Tang X2, Ratanatharathorn C5, Ji Y5, Mirshahidi S3, Chen CS6.
1 Division of Hematology/Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA. Electronic address: hcao at llu.edu.
2 Department of Medicine, Division of Regenerative Medicine, Loma Linda University, Loma Linda, CA, USA.
3 Biospecimen Laboratory, Loma Linda University Cancer Center, Loma Linda University School of Medicine, Loma Linda, CA, USA.
4 Division of Anatomy, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
5 Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA.
6 Division of Hematology/Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Acute myeloid leukemia (AML) is characterized by the accumulation of malignant, transformed immature hematopoietic myeloid precursors that have lost their ability to differentiate and proliferate normally. Current treatment for AML requires intensive cytotoxic chemotherapy and results in significant morbidity and mortality, especially in older patients. Effective and better-tolerated treatment is urgently needed. Studies have shown that 1α,25-dihydroxyvitamin D3 (1,25-D3, active VD3) or vitamin D analogs (VDAs) can potently differentiate AML cells in vitro and ex vivo, which led to early clinical trials in AML and myelodysplastic syndrome patients. However, one major limiting factor in the clinical application of active VD3 or VDAs is the supraphysiologic dose required, which results in systemic hypercalcemia. Several important questions (i.e., dosage, method of delivery, metabolism of 1,25-D3 in situ, systemic hypercalcemia, and mechanisms of action of combination treatment) have to be addressed before vitamin D treatment can be applied to the clinical setting. This review focuses on 1,25-D3's mechanism of action in AML, preclinical data, and clinical trial outcomes, with an emphasis on major roadblocks to successful trials and suggestions for future directions.
PMID: 28174131 DOI: 10.1016/j.exphem.2017.01.007
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Low 25(OH) vitamin D3 levels are associated with adverse outcome in newly diagnosed, intensively treated adult acute myeloid leukemia.
Cancer. 2014 Feb 15;120(4):521-9. doi: 10.1002/cncr.28368. Epub 2013 Oct 25.
Lee HJ1, Muindi JR, Tan W, Hu Q, Wang D, Liu S, Wilding GE, Ford LA, Sait SN, Block AW, Adjei AA, Barcos M, Griffiths EA, Thompson JE, Wang ES, Johnson CS, Trump DL, Wetzler M.
Leukemia Section, Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, New York.
Several studies have suggested that low 25(OH) vitamin D3 levels may be prognostic in some malignancies, but no studies have evaluated their impact on treatment outcome in patients with acute myeloid leukemia (AML).
Vitamin D levels were evaluated in 97 consecutive, newly diagnosed, intensively treated patients with AML. MicroRNA expression profiles and single nucleotide polymorphisms (SNPs) in the 25(OH) vitamin D3 pathway genes were evaluated and correlated with 25(OH) vitamin D3 levels and treatment outcome.
- Thirty-four patients (35%) had normal 25(OH) vitamin D3 levels (32-100 ng/mL),
- 34 patients (35%) had insufficient levels (20-31.9 ng/mL), and
- 29 patients (30%) had deficient levels (<20 ng/mL).
Insufficient/deficient 25(OH) vitamin D3 levels were associated with worse relapse-free survival (RFS) compared with normal vitamin D3 levels. In multivariate analyses, deficient 25(OH) vitamin D3 , smoking, European Leukemia Network genetic group, and white blood cell count retained their statistical significance for RFS. Several microRNAs and SNPs were associated with 25(OH) vitamin D3 levels, although none remained significant after multiple test corrections; one 25(OH) vitamin D3 receptor SNP, rs10783219, was associated with a lower complete remission rate (P = .0442) and with shorter RFS (P = .0058) and overall survival (P = .0011).
It remains to be determined what role microRNA and SNP profiles play in contributing to low 25(OH) vitamin D3 level and/or outcome and whether supplementation will improve outcomes for patients with AML.
PMID: 24166051 PMCID: PMC3948325 DOI: 10.1002/cncr.28368
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