LeukemiaTreatment

One paper reported poorer prognosis for those with chronic lymphocytic leukemia/small lymphocytic lymphoma who had lower serum 25(OH)D levels:

We evaluated the relationship of 25(OH)D serum levels with time-to-treatment (TTT) and overall survival(OS) in newly diagnosed CLL patients participating in a prospective cohort study(discovery cohort) and a separate cohort of previously untreated patients participating in an observational study(confirmation cohort). Of 390 CLL patients in the discovery cohort, 119(30.5%) were 25(OH)D insufficient. After median follow-up of 3 years, TTT (hazard ratio [HR]=1.66; p=0.005) and OS (HR=2.39; p=0.01) were shorter for 25(OH)D insufficient patients. In the validation cohort, 61 of 153 patients (39.9%) were 25(OH)D insufficient. After median follow-up of 9.9 years, TTT (HR=1.59; p=0.05) and OS (HR 1.63; p=0.06) were again shorter for 25(OH)D insufficient patients. On pooled multivariable analysis of patients in both cohorts adjusting for age, sex, stage, CD38, ZAP-70, IGHV, CD49d, and FISH, 25(OH)D insufficiency remained an independent predictor of TTT (HR=1.47; p=0.008), although the association with OS was not significant (HR=1.47; p=0.07). Vitamin D insufficiency is associated with inferior TTT and OS in CLL patients. Whether normalizing vitamin D levels in deficient CLL patients would improve outcome merits clinical testing1.

These findings are encouraging, but whether they apply to other types of leukemia has not been determined. It seems premature for those with leukemia to increase serum 25(OH)D levels.

There is some evidence from laboratory studies that the active form of vitamin D, 1,25(OH)2D, can convert leukemia cells to non-leukemia cells2 3. These studies have not been translated to practice because using 1,25(OH)2D entails a considerable risk of inducing hypercalcemia4. Problems in the use of 1,25(OH)2D is still being investigated5.

Page last edited: 18 July 2011

References

  1. Shanafelt, T. D. Drake, M. T. Maurer, M. J. Allmer, C. Rabe, K. G. Slager, S. L. Weiner, G. J. Call, T. G. Link, B. K. Zent, C. S. Kay, N. E. Hanson, C. A. Witzig, T. E. Cerhan, J. R. Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia (CLL). Blood. 2010 Nov 3;
  2. Abe, E. Miyaura, C. Sakagami, H. Takeda, M. Konno, K. Yamazaki, T. Yoshiki, S. Suda, T. Differentiation of mouse myeloid leukemia cells induced by 1 alpha,25-dihydroxyvitamin D3. Proc Natl Acad Sci U S A. 1981 Aug; 78 (8): 4990-4.
  3. Hughes, P. J. Marcinkowska, E. Gocek, E. Studzinski, G. P. Brown, G. Vitamin D3-driven signals for myeloid cell differentiation–implications for differentiation therapy. Leuk Res. 2010 May; 34 (5): 553-65.
  4. Garay, E. Donnelly, R. Wang, X. Studzinski, G. P. Resistance to 1,25D-induced differentiation in human acute myeloid leukemia HL60-40AF cells is associated with reduced transcriptional activity and nuclear localization of the vitamin D receptor. J Cell Physiol. 2007 Dec; 213 (3): 816-25.
  5. Marcinkowska, E. Gocek, E. Heat shock protein 90 interacts with vitamin D receptor in human leukemia cells. J Steroid Biochem Mol Biol. 2010 Jul; 121 (1-2): 114-6.