Multiple myelomaVitamin D levels

There is limited information on risk of multiple myeloma (MM) with respect to serum 25(OH)D levels.

A recent cross-sectional study reported that the proportion of those diagnosed with MM had serum 25(OH)D levels considered deficient (less than 20 ng/ml) increased progressively with higher stage of MM at time of diagnosis: unadjusted odds ratio (OR) = 1.89 (95% confidence interval, 1.05-3.50) for stage II versus stage I, and 3.56 (1.11-12.23) for stage III versus stage I1. These results suggest that lower serum 25(OH)D levels are associated with poorer prognosis. However, as noted in the paper, lower serum 25(OH)D levels associated with more advanced stage of MM at time of diagnosis could be due to a physiological effect. It could also be due to spending less time in the sun. Thus, this study, too, provides only weak evidence.

A nested case-control study as part of Harvard’s Health Professionals Follow-Up Study found a significant inverse correlation between a vitamin D index and five types of cancer, and insignificant inverse correlations with six other types of cancer2. For MM, there was an insignificant increased multivariate relative risk with respect to this vitamin D index. The vitamin D index was developed from data on oral vitamin D intake and UVB irradiance as it related to serum 25(OH)D levels of 1000 of the men in the 50,000-men cohort.

A prospective study in Finland with 17.4 years of follow-up found the lowest risk of MM for those with serum 25(OH)D levels <40 nmol/L (16 ng/mL)3. The paper, however, mentioned that for non-Hodgkin’s lymphoma, “Cases diagnosed less than 7 years from the baseline showed an inverse association (OR for highest versus lowest tertile = 0.43; 95% CI: 0.23, 0.83; p for trend = 0.01), but not later diagnoses (OR = 1.52; 95% CI: 0.82, 2.80; p for trend = 0.17). This finding is in keeping with what has been found for breast cancer, that after a few years, the prognostic value of a single serum 25(OH)D level declines4 5. Thus, the finding for MM in this study is thought not to be representative of the effect of vitamin D on risk of MM.

A study in the United States from Surveillance, Epidemiology, and End Results registries found “Incidence among blacks was m twice that among whites; this disparity was greater among patients < 50 years (P = 0.002). Over the entire study period, disease-specific and relative survival rates were higher in blacks than whites (P < 0.001). Mean age at diagnosis was 65.8 and 69.8 years for blacks and whites, respectively (P < .001).”6. The disparity in incidence rates is consistent with a role of vitamin D. The disparity in survival rates might be related to the difference in age at time of diagnosis.

Page last edited: 18 July 2011

References

  1. Ng, A. C. Kumar, S. K. Rajkumar, S. V. Drake, M. T. Impact of vitamin D deficiency on the clinical presentation and prognosis of patients with newly diagnosed multiple myeloma. Am J Hematol. 2009 Jul; 84 (7): 397-400.
  2. Giovannucci, E. Liu, Y. Rimm, E. B. Hollis, B. W. Fuchs, C. S. Stampfer, M. J. Willett, W. C. Prospective study of predictors of vitamin D status and cancer incidence and mortality in men. J Natl Cancer Inst. 2006 Apr 5; 98 (7): 451-9.
  3. Lim, U. Freedman, D. M. Hollis, B. W. Horst, R. L. Purdue, M. P. Chatterjee, N. Weinstein, S. J. Morton, L. M. Schatzkin, A. Virtamo, J. Linet, M. S. Hartge, P. Albanes, D. A prospective investigation of serum 25-hydroxyvitamin D and risk of lymphoid cancers. Int J Cancer. 2009 Feb 15; 124 (4): 979-86.
  4. Robien, K. Cutler, G. J. Lazovich, D. Vitamin D intake and breast cancer risk in postmenopausal women: the Iowa Women’s Health Study. Cancer causes & control : CCC. 2007 Sep; 18 (7): 775-82.
  5. Grant, W. B. Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines. Dermato-endocrinology. 2011; 3 (3):
  6. Waxman, A. J. Mink, P. J. Devesa, S. S. Anderson, W. F. Weiss, B. M. Kristinsson, S. Y. McGlynn, K. A. Landgren, O. Racial disparities in incidence and outcome in multiple myeloma: a population-based study. Blood. 2010 Dec 16; 116 (25): 5501-6.