Division of Hematology, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Blood. 2011 Feb 3;117(5):1492-8. doi: 10.1182/blood-2010-07-295683. Epub 2010 Nov 3.
Vitamin D insufficiency is common globally and low levels are linked to higher cancer incidence. Although vitamin D insufficiency is related to inferior prognosis in some cancers, no data exist for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). We evaluated the relationship of 25(OH)D serum levels with time-to-treatment (TTT) and overall survival (OS) in newly diagnosed CLL patients participating in a prospective cohort study (discovery cohort) and a separate cohort of previously untreated patients participating in an observational study (confirmation cohort). Of 390 CLL patients in the discovery cohort, 119 (30.5%) were 25(OH)D insufficient. After a median follow-up of 3 years, TTT (hazard ratio[HR] = 1.66; P = .005) and OS (HR = 2.39; P = .01) were shorter for 25(OH)D-insufficient patients. In the validation cohort, 61 of 153 patients (39.9%) were 25(OH)D insufficient. After a median follow-up of 9.9 years, TTT (HR = 1.59; P = .05) and OS (HR 1.63; P = .06) were again shorter for 25(OH)D-insufficient patients. On pooled multivariable analysis of patients in both cohorts adjusting for age, sex, Rai stage, CD38 status, ZAP-70 status, immunoglobulin heavy chain variable (IGHV) gene mutation status, CD49d status, and cytogenetic abnormalities assessed by interphase fluorescent in situ hybridization testing, 25(OH)D insufficiency remained an independent predictor of TTT (HR = 1.47; P = .008), although the association with OS was not significant (HR = 1.47; P = .07). Vitamin D insufficiency is associated with inferior TTT and OS in CLL patients. Whether normalizing vitamin D levels in deficient CLL patients would improve outcome merits clinical testing.
维生素 D 不足在全球范围内很常见，低水平与更高的癌症发病率有关。尽管维生素 D 不足与某些癌症的预后不良有关，但尚无慢性淋巴细胞白血病/小淋巴细胞淋巴瘤 (CLL/SLL) 的相关数据。我们评估了血清 25(OH)D 水平与新诊断的 CLL 患者参与前瞻性队列研究（发现队列）和另一组未经治疗的患者参与观察性研究（确认队列）的治疗时间（TTT）和总生存（OS）之间的关系。在发现队列的 390 例 CLL 患者中，有 119 例（30.5%）存在 25(OH)D 不足。中位随访 3 年后，25(OH)D 不足患者的 TTT（危险比[HR] = 1.66；P =.005）和 OS（HR = 2.39；P =.01）较短。在验证队列中，153 例患者中有 61 例（39.9%）存在 25(OH)D 不足。中位随访 9.9 年后，25(OH)D 不足患者的 TTT（HR = 1.59；P =.05）和 OS（HR 1.63；P =.06）再次较短。在对两个队列的患者进行的多变量分析中，对年龄、性别、Rai 分期、CD38 状态、ZAP-70 状态、免疫球蛋白重链可变区（IGHV）基因突变状态、CD49d 状态和间期荧光原位杂交检测评估的细胞遗传学异常进行调整后，25(OH)D 不足仍然是 TTT 的独立预测因素（HR = 1.47；P =.008），尽管与 OS 的关联不显著（HR = 1.47；P =.07）。维生素 D 不足与 CLL 患者的 TTT 和 OS 不良相关。在 CLL 患者中纠正维生素 D 水平是否会改善预后值得临床检验。
