Patients Given Usual Doses of Vitamin D3 Persist with Vitamin D Insufficiency 100 Days Following Allogenic Stem Cell Transplant

Presentation Number: SUN 335
Date of Presentation: April 2nd, 2017

Mohammed Almohaya*1, Ni Bai2, Kiran Rikhraj3, Deepesh Lad4, David L Kendler1 and Raewyn Broady1
1University of British Columbia, Vancouver, BC, Canada, 2Leukemia BMT Program of BC, Canada, 3University of British Columbia, Vancouver BC, Canada, 4Post Graduate Institute of Medical Education and Research, India

Abstract

Patients with hematologic malignancies are being frequently managed with allogeneic hematologic stem cell transplant (AlloHSCT). Rapid declines in bone mineral density in the first 100 days post-transplant have been documented and attributed to chemotherapy, interactions between transplant stem cells and bone cells, graft-versus-host disease (GVHD), calcineurin antagonists, and glucocorticoid {Pawlowska, 2016 #248}(1). 25 hydroxy-vitamin D insufficiency prior to transplant may exacerbate bone loss and may predispose to GVHD (1, 2). Usual vitamin D supplementation may be ineffective for many reasons including impaired absorption of vitamin D in the event of GVHD of the G.I. tract.

We studied 87 patients (45 females and 42 females) who had 25 hydroxy-vitamin D determinations prior to AlloHSCT and at approximately 100 days subsequent to AlloHSCT. The majority of patients had acute myeloid leukemia (35%), myelodysplastic syndrome (16%) or acute lymphocytic leukemia (11%); the remainder had a variety of other hematologic malignancies. All patients were advised to take 1200 mg elemental calcium from diet and supplement combined and 2000 IU of vitamin D3 daily.

Pre-transplant 25 hydroxy-vitamin D levels were sufficient (greater than 75 nmol/l) in 43%, insufficient (25 to 75 nmol/l) in 54%, and deficient (less than 25 nmol/l) in 2 patients. 100 days post-transplant, the average increase in 25 hydroxy-vitamin D in all patients was 15 nmol/l (p= 0.00058, CI: 83.4-96.1). 29% of patients did not have increases in their 25 hydroxy-vitamin D levels despite the recommended supplementation. 15% of patients had a decline of 25 hydroxy vitamin D from sufficient to insufficient, not attributable to age, gender, glucocorticoid use or GVHD. In patients who were deficient or insufficient at baseline, mean 25 hydroxy-vitamin D increased from 53 to 81 nmol/l (p= 0.00031, CI: 74.1-88.3), however 47 % of patients did not achieve vitamin D sufficiency by 100 days post AlloHSCT. Those patients with vitamin D insufficiency at day 100 were more likely to have GVHD (60%), be on glucocorticoid (53%), or report not having taken vitamin D supplements as advised (17%).

We conclude that recommending to patients the usual daily vitamin D3 supplementation subsequent to AlloHSCT is unreliable in achieving vitamin D sufficiency. A pre-transplant loading dose of vitamin D3 may be required in order to achieve and maintain vitamin D sufficiency post -transplant. In addition to likely benefits to bone health, further research is required to document whether other aspects of patients’ post-transplant health may be benefited by strategies targeted to maintaining vitamin D sufficiency.

 

Disclosure: DLK: Consultant, Merck & Co., Consultant, Eli Lilly & Company, Consultant, Astra Zeneca, Consultant, Astallis, Consultant, Amgen. Nothing to Disclose: MA, NB, KR, DL, RB