Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Service d'Hématologie, Toulouse, France.
Université Toulouse III Paul Sabatier, Toulouse, France.
Blood Adv. 2023 Nov 28;7(22):6886-6897. doi: 10.1182/bloodadvances.2023010559.
Recent studies have highlighted the role of vitamin C and D in acute myeloid leukemia (AML). In 2018, we changed our practices to add both vitamins to the supportive care for all consecutive patients with AML undergoing intensive chemotherapy. In this study, we compared the outcomes of patients treated before and after this change in practice. From 2015 to 2020, 431 patients were included, 262 of whom received no supplementation and 169 of whom received vitamin supplementation. Vitamin C and vitamin D was administered from day 10 of chemotherapy until hematologic recovery from induction and consolidation. Most patients presented at diagnosis with low levels of vitamin C and D. Upon recovery from induction, vitamin D levels among the vitamin C/D group significantly increased compared with those at diagnosis, and pretransplant levels were significantly higher in the vitamin C/D group compared with the control group (median of 33 vs 19 ng/mL; P < .0001). During induction, the rates of bacterial or fungal infection, hemorrhage, or macrophage activation syndrome were lower in the vitamin C/D group, whereas there was no difference in response rate, relapse incidence, and overall survival (OS). However, the multivariate analysis for OS showed a significant interaction between vitamin C/D and NPM1 mutation, meaning that vitamin C/D supplementation was significantly and independently associated with better OS in patients with NPM1 mutations (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.30-0.90; P = .019) compared with patients with wild-type NPM1 (HR, 1.01; 95% CI, 0.68-1.51; P = .95). In conclusion, vitamin C/D supplementation is safe and could influence the outcomes of patients with AML undergoing intensive chemotherapy.
最近的研究强调了维生素 C 和 D 在急性髓系白血病 (AML) 中的作用。2018 年，我们改变了治疗方案，在接受强化化疗的所有 AML 连续患者的支持性护理中添加了这两种维生素。在这项研究中，我们比较了在这种治疗方案改变前后接受治疗的患者的结局。2015 年至 2020 年，共纳入 431 例患者，其中 262 例未接受补充治疗，169 例接受了维生素补充治疗。维生素 C 和维生素 D 从化疗第 10 天开始给予，直到诱导和巩固期的血液学恢复。大多数患者在诊断时维生素 C 和 D 水平较低。在诱导期恢复后，与诊断时相比，维生素 C/D 组的维生素 D 水平显著增加，且移植前水平在维生素 C/D 组显著高于对照组（中位数分别为 33 与 19 ng/mL；P<0.0001）。在诱导期，维生素 C/D 组的细菌或真菌感染、出血或巨噬细胞活化综合征发生率较低，而缓解率、复发率和总生存率（OS）无差异。然而，OS 的多变量分析显示维生素 C/D 与 NPM1 突变之间存在显著交互作用，这意味着维生素 C/D 补充与 NPM1 突变患者的 OS 显著相关（风险比 [HR]，0.52；95%置信区间 [CI]，0.30-0.90；P=0.019），与野生型 NPM1 患者相比（HR，1.01；95%CI，0.68-1.51；P=0.95）。总之，维生素 C/D 补充是安全的，可能会影响接受强化化疗的 AML 患者的结局。
