Kelly Jennifer L, Salles Gilles, Goldman Bryan, Fisher Richard I, Brice Pauline, Press Oliver, Casasnovas Olivier, Maloney David G, Soubeyran Pierre, Rimsza Lisa, Haioun Corinne, Xerri Luc, LeBlanc Michael, Tilly Hervé, Friedberg Jonathan W
Jennifer L. Kelly and Jonathan W. Friedberg, James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY; Gilles Salles, Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Pierre Benite; Pauline Brice, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris; Olivier Casasnovas, Centre Hospitalo-Universitaire de Dijon, Dijon; Pierre Soubeyran, Institut Bergonié and Université Victor Segalen Bordeaux 2, Bordeaux; Corinne Haioun, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Créteil; Luc Xerri, Institut Paoli Calmettes, Marseille; Hervé Tilly, Centre Henri Becquerel, Rouen, France; Bryan Goldman, Oliver Press, and Michael LeBlanc, SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA; Richard I. Fisher, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA; and Lisa Rimsza, University of Arizona, Tucson, AZ.
J Clin Oncol. 2015 May 1;33(13):1482-90. doi: 10.1200/JCO.2014.57.5092. Epub 2015 Mar 30.
Recent literature reports a potential association between high vitamin D and improved lymphoma prognosis. We evaluated the impact of pretreatment vitamin D on follicular lymphoma (FL) outcome.
SWOG participants were previously untreated patients with FL enrolled onto SWOG clinical trials (S9800, S9911, or S0016) involving CHOP chemotherapy plus an anti-CD20 antibody (rituximab or iodine-131 tositumomab) between 1998 and 2008. Participants included in our second independent cohort were also previously untreated patients with FL enrolled onto the Lymphoma Study Association (LYSA) PRIMA trial of rituximab plus chemotherapy (randomly assigned to rituximab maintenance v observation) between 2004 and 2007. Using the gold-standard liquid chromatography-tandem mass spectrometry method, 25-hydroxyvitamin D was measured in stored baseline serum samples. The primary end point was progression-free survival (PFS).
After a median follow-up of 5.4 years, the adjusted PFS and overall survival hazard ratios for the SWOG cohort were 1.97 (95% CI, 1.10 to 3.53) and 4.16 (95% CI, 1.66 to 10.44), respectively, for those who were vitamin D deficient (< 20 ng/mL; 15% of cohort). After a median follow-up of 6.6 years, the adjusted PFS and overall survival hazard ratios for the LYSA cohort were 1.50 (95% CI, 0.93 to 2.42) and 1.92 (95% CI, 0.72 to 5.13), respectively, for those who were vitamin D deficient (< 10 ng/mL; 25% of cohort).
Although statistical significance was not reached in the LYSA cohort, the consistent estimates of association between low vitamin D levels and FL outcomes in two independent cohorts suggests that serum vitamin D might be the first potentially modifiable factor to be associated with FL survival. Further investigation is needed to determine the effects of vitamin D supplementation in this clinical setting.
近期文献报道高维生素D水平与淋巴瘤预后改善之间可能存在关联。我们评估了治疗前维生素D对滤泡性淋巴瘤（FL）预后的影响。
SWOG的参与者为1998年至2008年间入组SWOG临床试验（S9800、S9911或S0016）的初治FL患者，这些试验采用CHOP化疗加抗CD20抗体（利妥昔单抗或碘-131托西莫单抗）。纳入我们第二个独立队列的参与者也是2004年至2007年间入组淋巴瘤研究协会（LYSA）PRIMA试验的初治FL患者，该试验为利妥昔单抗联合化疗（随机分配至利妥昔单抗维持治疗或观察）。采用金标准液相色谱-串联质谱法，对储存的基线血清样本中的25-羟基维生素D进行测量。主要终点为无进展生存期（PFS）。
中位随访5.4年后，SWOG队列中维生素D缺乏（<20 ng/mL；占队列的15%）患者的校正PFS和总生存风险比分别为1.97（95%CI，1.10至3.53）和4.16（95%CI，1.66至10.44）。中位随访6.6年后，LYSA队列中维生素D缺乏（<10 ng/mL；占队列的25%）患者的校正PFS和总生存风险比分别为1.50（95%CI，0.93至2.42）和1.92（95%CI，0.72至5.13）。
尽管LYSA队列未达到统计学显著性，但两个独立队列中维生素D水平低与FL预后之间一致的关联估计表明，血清维生素D可能是首个与FL生存相关的潜在可改变因素。需要进一步研究以确定在这种临床情况下补充维生素D的效果。
