Vitamin D Level after Allogeneic Hematopoietic Stem Cell Transplant

Abstract

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.

Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

“…29,30 In line with this, we observed a median vitamin D level before transplantation below sufficiency levels and the deficiency being further aggravated in the post-transplant period. It is likely that hospitalization and the prevailing recommendations to avoid sun exposure to prevent triggering of GvHD partly explain the decline in vitamin D levels following transplantation observed in this study.…”

Vitamin D Deficiency in Pediatric Hematopoietic Stem Cell Transplantation Patients Despite Both Standard and Aggressive Supplementation

“…Standard doses of multivitamins delivered in TPN are inadequate to maintain sufficient VD levels in HSCT recipients. In addition, many patients are already VD-deficient at the start of the transplantation process [1,11]. The cushingoid body habitus often observed in a HSCT population also increases VD supplementation needs [12].…”

Vitamin D receptor upregulation in alloreactive human T cells

“…In patients undergoing allogeneic stem cell transplants (allo-SCT), we recently reported that 70% of patients are vitamin D deficient on day 0 and 57% are deficient on day 100 [10]. Other investigators have reported vitamin D deficiency is as high as 90% in allo-SCT recipients, [11,12]. Taken together, the high incidence of vitamin D deficiency in allo-SCT patients emphasizes the need for further study of the impact of vitamin D deficiency on clinical outcomes.…”