Beebe Kristen, Magee Kyrie, McNulty Annmarie, Stahlecker Jennifer, Salzberg Dana, Miller Holly, Mirea Lucia, Adams Roberta, Ngwube Alexander
Center for Cancer and Blood Disorder, Phoenix Children's Hospital, Phoenix, Arizona.
Pediatr Blood Cancer. 2018 Feb;65(2). doi: 10.1002/pbc.26817. Epub 2017 Sep 27.
Pediatric patients undergoing hematopoietic stem cell transplantation (HSCT) are frequently diagnosed with vitamin D deficiency, which may impact outcomes.
To estimate the prevalence of vitamin D deficiency and examine its association with short-term survival in pediatric HSCT patients.
Patients undergoing HSCT at Phoenix Children's Hospital were retrospectively identified. Routine serum 25-hydroxyvitamin D measurements were described prior to transplant and at 100 days and 1-year post-HSCT. Associations of pre-HSCT vitamin D groups (i.e., normal ≥30 ng/ml, insufficient 20-29 ng/ml, and deficient <30 ng/ml) with demographics, clinical factors, and outcomes were examined using nonparametric tests and Cox proportional hazards analyses.
Among 72 study subjects, the median vitamin D pre-HSCT was 26 ng/ml (range: 19-34 ng/ml). Levels were insufficient and deficient in 25 (35%) and 20 (28%) patients, respectively, with only two (3%) patients on supplemental therapy pre-HSCT. Despite supplemental therapy provided to 46 (74%) subjects, insufficient/deficient rates did not significantly change between pre-HSCT and 100 days post-HSCT, but mean vitamin D levels significantly increased by 1-year post-HSCT (P = 0.01).Vitamin D pre-HSCT was not associated with the development of acute or chronic graft-versus-host disease (GVHD) or delayed engraftment. Overall 1-year survival was significantly lower for patients with deficient (65%) compared to normal (93%) pre-HSCT vitamin D (P = 0.001).
Suboptimal vitamin D levels are common in pediatric patients scheduled to receive HSCT and are associated with lower overall 1-year survival. Further study is warranted to delineate the mechanisms underlying the role of vitamin D in successful HSCT.
接受造血干细胞移植（HSCT）的儿科患者经常被诊断为维生素D缺乏，这可能会影响治疗结果。
评估儿科HSCT患者维生素D缺乏的患病率，并研究其与短期生存的相关性。
对在凤凰城儿童医院接受HSCT的患者进行回顾性识别。描述移植前、HSCT后100天和1年时的常规血清25-羟基维生素D测量值。使用非参数检验和Cox比例风险分析，研究HSCT前维生素D组（即正常≥30 ng/ml、不足20-29 ng/ml和缺乏<20 ng/ml）与人口统计学、临床因素和治疗结果之间的关联。
在72名研究对象中，HSCT前维生素D的中位数为26 ng/ml（范围：19-34 ng/ml）。分别有25名（35%）和20名（28%）患者的维生素D水平不足和缺乏，HSCT前只有2名（3%）患者接受补充治疗。尽管46名（74%）受试者接受了补充治疗，但HSCT前和HSCT后100天之间不足/缺乏率没有显著变化，但HSCT后1年时维生素D平均水平显著升高（P = 0.01）。HSCT前维生素D与急性或慢性移植物抗宿主病（GVHD）的发生或植入延迟无关。与HSCT前维生素D正常（93%）的患者相比，缺乏（65%）的患者总体1年生存率显著降低（P = 0.001）。
计划接受HSCT的儿科患者中维生素D水平不理想很常见，且与总体1年生存率较低有关。有必要进一步研究以阐明维生素D在成功HSCT中作用的潜在机制。
