Kenny Sheila A, Collum Karen, Featherstone Catherine A, Farooki Azeez, Jakubowski Ann
Memorial Sloan Kettering Cancer Center, New York, New York.
Weill Cornell Medical College, Cornell University, and Memorial Sloan Kettering Cancer Center, New York, New York.
J Adv Pract Oncol. 2019 Mar;10(2):109-118. Epub 2019 Mar 1.
Adults undergoing hematopoietic stem cell transplant (HSCT) are at risk for vitamin D deficiency. After HSCT, exposure to sunlight is restricted, and patients may experience poor nutrition and malabsorption from HSCT-related side effects. Vitamin D affects bone health and immunologic processes. The aim of this project is to establish a process for monitoring and treating vitamin D deficiency and to evaluate if therapeutic vitamin D levels are attainable posttransplant using an HSCT vitamin D replacement algorithm. A multidisciplinary group led by advanced practice providers established a workflow for monitoring and supplementing vitamin D and created an HSCT vitamin D replacement guideline. The medical records of 144 adult HSCT patients were reviewed, and the records of another 72 patients were reviewed a year later. Historical baseline data before the intervention found that 81% of patients were vitamin D deficient and 30% received supplementation. Postintervention and at 1-year follow-up, 76% and 65% of patients were vitamin D deficient before transplant and 97.1% and 100%, respectively, received supplementation for vitamin D deficiency. Post-HSCT compliance with monitoring demonstrated that approximately 91% of patients had a vitamin D level checked within 6 months of transplant. After implementation of the algorithm, there was a statistically significant difference ( < .001) between deficient vitamin D levels pretransplant (72.9%) and posttransplant (26.4%). Results demonstrate sustained compliance over a 2-year period with monitoring and supplementation of vitamin D pre- and peritransplant. Aggressive vitamin D repletion posttransplant decreased the incidence of vitamin D deficiency in HSCT patients. Further study is needed to investigate the long-term effects of vitamin D repletion on posttransplant complications.
接受造血干细胞移植（HSCT）的成年人存在维生素D缺乏风险。HSCT后，阳光照射受限，患者可能因HSCT相关副作用出现营养不良和吸收不良。维生素D影响骨骼健康和免疫过程。本项目的目的是建立监测和治疗维生素D缺乏的流程，并使用HSCT维生素D替代算法评估移植后是否可达到治疗性维生素D水平。由高级执业提供者领导的多学科团队建立了监测和补充维生素D的工作流程，并制定了HSCT维生素D替代指南。回顾了144例成年HSCT患者的病历，并在一年后回顾了另外72例患者的病历。干预前的历史基线数据发现，81%的患者维生素D缺乏，30%接受了补充。干预后及1年随访时，移植前维生素D缺乏的患者分别为76%和65%，维生素D缺乏接受补充的患者分别为97.1%和100%。HSCT后监测的依从性表明，约91%的患者在移植后6个月内检查了维生素D水平。实施该算法后，移植前（72.9%）和移植后（26.4%）维生素D缺乏水平存在统计学显著差异（<0.001）。结果表明，在移植前和移植期间对维生素D进行监测和补充，在2年期间保持了持续的依从性。移植后积极补充维生素D降低了HSCT患者维生素D缺乏的发生率。需要进一步研究以调查补充维生素D对移植后并发症的长期影响。
