Division of Pediatric Hem/Onc/BMT, Nationwide Children's Hospital, Columbus, OH, USA.
Division of Endocrinology, Metabolism and Diabetes, Nationwide Children's Hospital, Columbus, OH, USA.
Pediatr Transplant. 2021 Jun;25(4):e14008. doi: 10.1111/petr.14008. Epub 2021 Mar 18.
Vitamin D not only plays an important role in bone metabolism but is also involved in multiple immune-mediated processes in the body which may be adversely affected in those with low levels. Most pediatric studies evaluating the association of vitamin D in patients undergoing allogeneic HSCT are single-center studies. We present the results of retrospective study at 5 centers across the United States in pediatric patients undergoing allogeneic HSCT. (VDD) and (VDI) were defined by vitamin D levels of <20 ng/ml and 21-30 ng/ml, respectively. The mean vitamin D levels pre-HSCT, day +30, and +100 were suggestive of VDI, but normalized thereafter. We compared the transplant characteristics and outcomes in 233 patients with VDD and VDI and those with normal levels and found no statistical difference in neutrophil or platelet engraftment, infections (viral, bacterial, or fungal) post-HSCT, length of hospital stay during HSCT, graft failure, acute or chronic GvHD, survival at day +100 and 1 year, or relapse of primary malignancy. We conclude that VDI or deficiency does not affect any of the common transplant variables after allogeneic HSCT in children. There is a need of a large multicenter prospective study to evaluate its role further.
维生素 D 不仅在骨骼代谢中发挥重要作用，而且还参与体内多种免疫介导的过程，而这些过程在维生素 D 水平较低的人群中可能会受到不利影响。大多数评估接受异基因 HSCT 的患者维生素 D 相关性的儿科研究都是单中心研究。我们在美国 5 个中心的回顾性研究结果表明，接受异基因 HSCT 的儿科患者中存在维生素 D 缺乏（VDD）和维生素 D 不足（VDI）。（VDD）和（VDI）分别定义为维生素 D 水平<20ng/ml 和 21-30ng/ml。HSCT 前、+30 天和+100 天的平均维生素 D 水平提示 VDI，但此后恢复正常。我们比较了 233 例 VDD 和 VDI 患者与正常水平患者的移植特征和结局，发现中性粒细胞或血小板植入、HSCT 后感染（病毒、细菌或真菌感染）、HSCT 期间住院时间、移植物衰竭、急性或慢性移植物抗宿主病、+100 天和 1 年生存率或原发性恶性肿瘤复发等方面无统计学差异。我们的结论是，维生素 D 不足或缺乏不会影响儿童异基因 HSCT 后任何常见的移植变量。需要进行大型多中心前瞻性研究来进一步评估其作用。
