Lazarow Heather, Carulli Alison, McWilliams Tara, Kucharczuk Colleen, Hollander Lauren, Catania Christopher, Munshi Pashna, Gabriel Peter, Loren Alison, Porter David, Baumrin Emily
Clinical Nutrition Support Services, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Support Care Cancer. 2025 Aug 5;33(9):755. doi: 10.1007/s00520-025-09778-y.
Hypovitaminosis C is observed in patients with hematologic malignancy, including those receiving hematopoietic cell transplantation (HCT). This study examines longitudinal vitamin C levels and inflammatory markers in patients receiving allogeneic HCT and determines the impact of treated hypovitaminosis C prior to conditioning on clinical outcomes, including mucositis.
Adults were prospectively enrolled at the time of admission for allogeneic HCT. Clinical outcomes were compared between patients with normal vitamin C, hypovitaminosis C, and indeterminate vitamin C due to acute inflammation prior to conditioning. Patients with hypovitaminosis C were given ascorbic acid supplementation at standard dosages.
Sixty patients were enrolled (37 [62%] male, median age 61 years [range 22-75]), 19 (32%) with hypovitaminosis C, 28 (47%) with normal vitamin C, and 13 (22%) with indeterminate vitamin C stores due to the presence of inflammation (CRP). Patients with baseline hypovitaminosis C receiving standard dose supplementation had no difference in mucositis outcomes compared to patients with baseline normal vitamin C (adjusted odds ratio [aOR] grade III/IV mucositis=2.64 [0.44-17.96], p=0.29 and aOR hemorrhagic mucositis=0.50 [0.12-1.86], p=0.30) but did have higher odds of persistent hypovitaminosis C after discharge despite supplementation (aOR 3.71 [CI 1.05-14.22], p=0.04). Patients with high baseline CRP had higher odds of grade III/IV mucositis (aOR 8.06 [1.27-74.31], p=0.03), hemorrhagic mucositis (aOR 4.78 [1.09-25.46], p=0.04), and post-discharge hypovitaminosis C (aOR 17.80 [3.04-196.41], p=0.001).
Hypovitaminosis C is prevalent prior to allogeneic HCT. Patients with hypovitaminosis C treated with standard ascorbic acid repletion had no difference in clinical outcomes compared to patients with normal vitamin C levels; however, repletion was not sufficient to restore normal vitamin C levels. Patients with high baseline CRP and thus indeterminate vitamin C stores had worse clinical outcomes overall including severe mucositis. Optimal timing and dosing of vitamin C supplementation should be determined.
血液系统恶性肿瘤患者，包括接受造血细胞移植（HCT）的患者，存在维生素C缺乏症。本研究检测接受异基因HCT患者的维生素C水平和炎症标志物的纵向变化，并确定预处理前治疗维生素C缺乏症对包括口腔黏膜炎在内的临床结局的影响。
对异基因HCT入院时的成人患者进行前瞻性登记。比较预处理前维生素C水平正常、维生素C缺乏症和因急性炎症导致维生素C水平不确定的患者的临床结局。维生素C缺乏症患者给予标准剂量的抗坏血酸补充剂。
共登记60例患者（37例[62%]为男性，中位年龄61岁[范围22 - 75岁]），19例（32%）患有维生素C缺乏症，28例（47%）维生素C水平正常，13例（22%）因存在炎症（CRP）导致维生素C储备情况不确定。基线维生素C缺乏症且接受标准剂量补充剂的患者与基线维生素C水平正常的患者相比，口腔黏膜炎结局无差异（调整优势比[aOR]为III/IV级口腔黏膜炎 = 2.64 [0.44 - 17.96]，p = 0.29；aOR为出血性口腔黏膜炎 = 0.50 [0.12 - 1.86]，p = 0.30），但出院后尽管补充了维生素C，仍持续存在维生素C缺乏症的几率更高（aOR为3.71 [CI 1.05 - 14.22]，p = 0.04）。基线CRP水平高的患者发生III/IV级口腔黏膜炎（aOR为8.06 [1.27 - 74.31]，p = 0.03）、出血性口腔黏膜炎（aOR为4.78 [1.09 - 25.46]，p = 0.04）和出院后维生素C缺乏症（aOR为17.80 [3.04 - 196.41]，p = 0.001）的几率更高。
异基因HCT前维生素C缺乏症很普遍。接受标准抗坏血酸补充治疗的维生素C缺乏症患者与维生素C水平正常的患者相比，临床结局无差异；然而，补充不足不足以恢复正常维生素C水平。基线CRP水平高且因此维生素C储备情况不确定的患者总体临床结局更差，包括严重口腔黏膜炎。应确定维生素C补充的最佳时机和剂量。
