Association of Pretransplant Vitamin D Deficiency and Relapse in Myeloid Malignancies


Key Points

  • Pretransplant vitamin D deficiency was associated with an increased risk of relapse in myeloid malignancies.
  • An increased risk of relapse was observed in a validation cohort.

A German retrospective study has found that pretransplantation vitamin D deficiency is associated with an increased risk of relapse in patients undergoing allogeneic stem cell transplantation (SCT) for myeloid malignancies. These findings were reported by Radujkovic et al in the Journal of Clinical Oncology.

Study Details

The retrospective study involved a training cohort of 492 patients undergoing allogeneic SCT for myeloid and lymphoid malignancies at the University Hospital Heidelberg between 2002 and 2013. Vitamin D deficiency was defined as a serum level of 25-hydroxyvitamin D3 < 20 ng/mL (equivalent to < 50 nM) before transplantation and was assessed using a standard chemiluminescent immunoassay. Results were validated in an independent cohort of 398 patients diagnosed with myeloid malignancies who underwent allogeneic SCT at the University Hospital Essen between 2009 and 2013 and had serum samples available for measurement of vitamin D levels.

Association With Relapse

A total of 396 patients (80%) in the training cohort and 348 patients (87%) in the validation cohort had pretransplantation vitamin D deficiency. In a multivariate analysis, deficiency was significantly associated with inferior overall survival in the training cohort (hazard ratio [HR] = 1.78, P = .007), with the decreased survival reflecting a higher risk of relapse (HR = 1.96, P = .006) rather than nonrelapse mortality (HR = 1.72, P = .088). The association of deficiency with relapse was significant among patients with myeloid (HR = 2.55, P = .014) but not lymphoid disease (HR = 1.60, P = .147).

In the validation cohort of patients with myeloid malignancies, vitamin D deficiency was associated with a significantly increased risk of relapse (HR = 2.60, P = .017), with no significant increase in overall mortality (HR = 1.19, P = .420) or nonrelapse mortality (HR = 0.90, P = .663).

The investigators concluded: “Pretransplant [vitamin D] deficiency was associated with a higher risk of relapse in patients allografted for myeloid malignancies. Prospective studies on [vitamin D] status and correction of [vitamin D] deficiency in the setting of [allogeneic] SCT are highly warranted.”

The study was supported by B.L.U.T. e.V. (Weingarten) and a grant from the European Union’s Seventh Framework Programme.

Thomas Luft, MD, PhD, of the University Hospital Heidelberg, is the corresponding author of the Journal of Clinical Oncology article. 

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