Hansson Magnus E A, Norlin Anna-Carin, Omazic Brigitta, Wikström Ann-Charlotte, Bergman Peter, Winiarski Jacek, Remberger Mats, Sundin Mikael
Division of Pediatrics, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Immunology and Transfusion Medicine, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden.
Biol Blood Marrow Transplant. 2014 Oct;20(10):1537-43. doi: 10.1016/j.bbmt.2014.05.030. Epub 2014 Jun 5.
The importance of vitamin D in immunologic processes has recently emerged, but whether it has any impact on the course of allogeneic hematopoietic stem cell transplantation (HSCT) has not been determined. Reports indicate that HSCT recipients, particularly children, often suffer from vitamin D deficiency. This study investigated the role of vitamin D in 123 children undergoing HSCT from 2004 to 2011. Vitamin D (ie, serum calcidiol) was analyzed in collected cryostored samples. Patients were grouped according to pre-HSCT calcidiol level: insufficient (<50 nm/L, n = 38) and sufficient (≥50 nm/L, n = 85). Older children who underwent transplants from January through June and children of Middle Eastern or African origin were more commonly found in the insufficient group. Acute grades II to IV graft-versus-host disease occurred more frequently in the vitamin D sufficient group (47% versus 30%, P = .05), whereas no difference was demonstrated for chronic graft-versus-host disease. The neutrophil granulocytes rose significantly faster in the vitamin D sufficient group. No difference in lymphocyte counts, immunoglobulin levels, or infectious disease burden during the first year post-HSCT were observed. Among children with malignancies, overall survival was significantly better in the sufficient group (87% versus 50%, P = .01). In addition, rejection (0% versus 11%, P = .06) and relapse (4% versus 33%, P = .03) rates were lower in patients with sufficient vitamin D levels. To conclude, vitamin D may have an important impact on the outcome of pediatric HSCT, particularly in patients with malignant disease. Further studies investigating whether vitamin D acts as an immunomodulator or is merely a surrogate marker of patient health or nutritional status are warranted.
维生素D在免疫过程中的重要性最近才显现出来，但它对异基因造血干细胞移植（HSCT）过程是否有影响尚未确定。报告表明，HSCT受者，尤其是儿童，经常患有维生素D缺乏症。本研究调查了2004年至2011年间123名接受HSCT儿童中维生素D的作用。对收集的冷冻保存样本中的维生素D（即血清骨化二醇）进行分析。根据HSCT前骨化二醇水平将患者分组：不足组（<50 nmol/L，n = 38）和充足组（≥50 nmol/L，n = 85）。1月至6月接受移植的大龄儿童以及中东或非洲裔儿童在不足组中更为常见。维生素D充足组急性II至IV级移植物抗宿主病的发生率更高（47%对30%，P = 0.05），而慢性移植物抗宿主病未显示出差异。维生素D充足组中性粒细胞升高明显更快。HSCT后第一年淋巴细胞计数、免疫球蛋白水平或感染性疾病负担无差异。在患有恶性肿瘤的儿童中，充足组的总生存率显著更高（87%对50%，P = 0.01）。此外，维生素D水平充足的患者排斥率（0%对11%，P = 0.06）和复发率（4%对33%，P = 0.03）更低。总之，维生素D可能对儿童HSCT的结果有重要影响，尤其是对患有恶性疾病的患者。有必要进一步研究维生素D是作为免疫调节剂发挥作用，还是仅仅是患者健康或营养状况的替代标志物。
