Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
Hematol Oncol. 2020 Oct;38(4):523-530. doi: 10.1002/hon.2774. Epub 2020 Jul 29.
High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) is applied for consolidation in myeloma and relapsing lymphoma patients. Vitamin D (VitD) exerts effects during hematopoietic stem cell proliferation, differentiation and interactions with the immune system. VitD deficiency is frequent in patients with hematological malignancies, but its prognostic relevance after ASCT remains unclear. We investigated the effect of VitD serum levels in patients with lymphomas and myeloma at ASCT on progression-free (PFS) and overall survival (OS). The cohort (n = 183) was divided into two groups: 81 (44%) had VitD levels >52 nmol/L and 102 (56%) ≤52 nmol/L at ASCT. VitD levels >52 nmol/L were associated with better PFS (P = 0.0194) and OS (P = 0.011). Similarly, when evaluating myeloma patients alone, patients with lower VitD levels (≤52 nmol/L) had inferior PFS (P = 0.0412) and OS (P = 0.049). Finally, the multivariate analysis was consistent that varying VitD levels were significantly associated with OS (P = 0.0167), also when stratifying patients in groups with VitD levels > versus ≤52 nmol/L (P = 0.0421). Our data suggest that reduced serum VitD levels in myeloma and lymphoma patients undergoing HDCT/ASCT are associated with inferior outcome. Optimizing VitD levels before ASCT may be warranted.
大剂量化疗（HDCT）联合自体干细胞移植（ASCT）用于骨髓瘤和复发性淋巴瘤患者的巩固治疗。维生素 D（VitD）在造血干细胞增殖、分化和与免疫系统相互作用过程中发挥作用。血液恶性肿瘤患者常存在 VitD 缺乏，但 ASCT 后其预后相关性尚不清楚。我们研究了 ASCT 时淋巴瘤和骨髓瘤患者 VitD 血清水平对无进展生存期（PFS）和总生存期（OS）的影响。该队列（n = 183）分为两组：81 例（44%）ASCT 时 VitD 水平＞52 nmol/L，102 例（56%）≤52 nmol/L。VitD 水平＞52 nmol/L 与更好的 PFS（P = 0.0194）和 OS（P = 0.011）相关。同样，当单独评估骨髓瘤患者时，VitD 水平较低（≤52 nmol/L）的患者 PFS（P = 0.0412）和 OS（P = 0.049）更差。最后，多变量分析表明，VitD 水平的变化与 OS 显著相关（P = 0.0167），当将患者按 VitD 水平＞与≤52 nmol/L 分组时也具有显著相关性（P = 0.0421）。我们的数据表明，接受 HDCT/ASCT 的骨髓瘤和淋巴瘤患者血清 VitD 水平降低与预后不良相关。ASCT 前优化 VitD 水平可能是必要的。
