High incidence of vitamin D deficiency in patients undergoing allogeneic stem cell transplantation – Letter
Richard W. Joseph1,*,†; Amin Alousi1; Bhavana Konda2; Krishna Komanduri3; Joyce Neumann1; Cindy Trevino1; Karen Stolar1; Muzaffar Qazibash1; Chitra Hosing1; Partow Kebriaei1; Daniel R. Couriel1; Richard E. Champlin1; Rima Saliba1; Uday Popat1
1 Department of Stem Cell Transplant and Cellular Therapy, MD Anderson Cancer Center, Houston, TX
2 Department of Internal Medicine, University of Miami Miller School of Medicine, Regional Campus, Atlantis, FL
3 Adult Stem Stem Cell Transplant Program, Department of Medicine, University of Miami Sylvester Cancer Center, Miami, FL
Email: Richard W. Joseph (email@example.com)
DOI: 10.1002/ajh.22143; Vol. 86 Issue 8, American Journal of Hematology
Patients undergoing allogeneic stem cell transplants (SCT) are at increased risk for vitamin D deficiency through prolonged hospitalizations and avoidance of sunlight as well as decreased nutritional status and malabsorption related to an allogeneic SCT. Vitamin D deficiency was shown to be as high as
The purpose of this study was to confirm the high incidence of vitamin D deficiency in the pre and post allogeneic transplant setting, the demographic factors associated with vitamin D deficiency, and the correlation between vitamin D deficiency and osteopenia and osteoporosis in patients undergoing allogeneic stem cell transplantation.
We found that
- 70% of patients were vitamin D deficient at day 0 of an allogeneic SCT, and
- 58% of patients were vitamin D deficient at post transplant day 100.
The incidence of osteopenia and osteoporosis in day 100 of the post-transplant setting was 83% and 22% respectively, however there was no difference in incidence of osteopenia or osteoporosis in patients who were vitamin D deficient or non-deficient. Our study confirms the high incidence of vitamin D deficiency in patients undergoing allogeneic transplant patients. Am. J. Hematol., 2011. © 2011 Wiley-Liss, Inc.
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- 83% osteopenia
- 22% osteoporosis
"Yes. We address this in the full letter that is not published yet but I think Vitamin D deficiency is one of several factors that influences bone loss.
Other factors such as steroid use, heparin, pre transplant conditioning, etc likely play a role in bone loss so it's hard to implicate just Vitamin D deficiency.
Given the low cost and morbidity I would still recommend supplementing with Vitamin D if deficient. "
Google Search of web for "stem cell transplant " "vitamin D" 625,000 items July 2011
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Biol Blood Marrow Transplant. 2011 Jul;17(7):1079-83. Epub 2010 Dec 27.
Sproat L, Bolwell B, Rybicki L, Dean R, Sobecks R, Pohlman B, Andresen S, Sweetenham J, Copelan E, Kalaycio M.
Banner Blood and Marrow Transplant Program, Phoenix, Arizona.
Vitamin D (VD) deficiency can cause osteomalacia, bone pain, muscle weakness, fatigue, and increased risk of fracture, and may precipitate or exacerbate osteopenia and osteoporosis. Patients receiving treatment for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) may have limited exposure to sunlight and often experience gastrointestinal side effects that may decrease their ability to maintain an adequate VD level. We hypothesized that patients with AML and ALL would have a low VD level after allogeneic hematopoietic cell transplant (HCT), and that these patients would have a high incidence of osteoporosis/osteopenia. We therefore studied the incidence of low VD level and low bone mineral density after HCT. Of 289 patients with AML or ALL undergoing HCT between January 1, 2000, and January 31, 2009, at the Cleveland Clinic, 58 (20.1%) patients had VD testing after HCT. Of these, 52 (89.7%) patients had a low VD level, and 6 (10.3%) had a normal level.
Most patients with VD testing had graft-versus-host disease (GVHD) and were taking corticosteroids (94.8% and 98.3%, respectively).
Of the 49 patients with VD testing who also had bone mineral density testing, 65% had abnormal (low bone density) results. Only 21% of patients with VD testing were taking VD supplements prior to testing, and 65% had an elevated parathyroid hormone level. We found that most patients did not have VD testing after HCT, but those that did were very likely to have a low level and have low bone mineral density. Those with a low VD level were likely to have received corticosteroids, have GVHD, and have an elevated parathyroid hormone (PTH) level. Given the potential morbidity of low VD level, VD deficiency should be considered after HCT. Prospective study of VD level and its impact on morbidity and mortality after HCT is warranted.
Copyright © 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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