High Prevalence of Vitamin D Deficiency and Bone Disease in Hematopoietic Cell Transplant Patients: Is It Time to Do Routine Pre Transplant Evaluation?

Presentation Number: SAT 331
Date of Presentation: April 2nd, 2016

Nicole Lustig*1, Pablo F Florenzano1, Daniel Ernst2, Pablo Ramirez3 and Claudia Campusano4
1Pontificia Universidad Católica de Chile, Santiago, Chile, 2Pontificia Universidad Católica de Chile, Chile, 3Pontificia Universidad Católica de Chile, 4Pontificia Universidad Catolica de Chile, Santiago, Chile

Abstract

Introduction:

Patients undergoing hematopoietic cell transplantation (HCT) are at increased risk of osteoporosis and other metabolic bone diseases, mainly due to chemotherapy, immunosuppressive drugs, decreased nutritional status and hypogonadism frequently associated to these treatments.

Vitamin D deficiency could determine worse prognosis in these patients, as published in recent studies.

Current guidelines recommend “screening dual-photon densitometry at 1 year after transplantation in adult women, all allogeneic HCT recipients and patients who are at high risk for bone loss after transplantation” (1); however early alterations could be found even before transplant.

Objectives: To evaluate basal bone health parameters in patients pre-HCT.

Patients and Methods:

Observational study of patients undergoing HCT in our institution. Patients were evaluated for serum 25- hydroxyvitamin D levels (25-OHD), parathyroid hormone (PTH), calcium, phosphorus and bone densitometry (DXA). We determined the frequency of vitamin D deficiency and supplementation, secondary hyperparathyroidism and low bone mass (Z score <-2.0).

Results:

46 patients were studied. Main diagnoses were multiple myeloma (32,6%), acute lymphoblastic leukemia (21,7%), acute myeloid leukemia (19,5%), and Hodgkin's Lymphoma (15,2%). Median age was 45 years (range: 17-67) and 60,8% patients were males.

Median 25OHD level was 13.6 ng/ml, 98% patients had insufficiency levels (<30 ng/ml) and 80% had deficiency levels (<20 ng/ml); 43.5% of patients received Vitamin D supplementation, most of them 800 IU/day. Median PTH level was 62 pg/ml and 47,3% had secondary hyperparathyroidism. Low bone mass at femoral neck and lumbar spine was present in 7% and 14% of patients respectively.

Conclusions:

HCT patients represent a group of high prevalence of vitamin D deficiency, secondary hyperparathyroidism and low bone mass prior to transplantation.

Despite that current guidelines recommend evaluation of bone health parameters 1 year after HCT, according to our findings we suggest to consider a pre-HCT evaluation of these parameters in order to avoid complications and initiate early intervention.

 

Nothing to Disclose: NL, PFF, DE, PR, CC