Non-Hodgkin lymphomaTreatment

A recent study found increased survival Non-Hodgkin lymphoma (NHL) rate for those with higher serum 25(OH)D levels at time of diagnosis:

Patients and methods: We tested the hypothesis that circulating 25-hydroxyvitamin D [25(OH)D] levels are predictive of event-free survival (EFS) and overall survival (OS) in a prospective cohort of 983 newly diagnosed patients with NHL. 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were measured by liquid chromatography-tandem mass spectrometry.

Results: Mean age at diagnosis was 62 years (range, 19 to 94 years); 44% of patients had insufficient 25(OH)D levels (< 25 ng/mL) within 120 days of diagnosis. Median follow-up was 34.8 months; 404 events and 193 deaths (168 from lymphoma) occurred. After adjusting for known prognostic factors and treatment, 25(OH)D insufficient patients with diffuse large B-cell lymphoma (DLBCL) had inferior EFS (hazard ratio [HR], 1.41; 95% CI, 0.98 to 2.04) and OS (HR, 1.99; 95% CI, 1.27 to 3.13); 25(OH)D insufficient patients with T-cell lymphoma also had inferior EFS (HR, 1.94; 95% CI, 1.04 to 3.61) and OS (HR, 2.38; 95% CI, 1.04 to 5.41). There were no associations with EFS for the other NHL subtypes. Among patients with DLBCL and T-cell lymphoma, higher 1,25(OH)(2)D levels were associated with better EFS and OS, suggesting that any putative tumor 1-α-hydroxylase activity did not explain the 25(OH)D associations1

However, there is a caveat in treating those with NHL with vitamin D: risk of hypercalcemia.

About 15% of those diagnosed with NHL develop hypecalcemia, which can lead to metastasis of the cancer to the bones234. As elevated 1,25-dihydroxyvitamin D [1,25(OH)2D] level is also a risk factor for hypercalcemia5 and higher 25(OH)D levels can lead to higher 1,25(OH)2D levels6, those diagnosed with NHL and treated with vitamin D should have their serum 1,25(OH)2D and calcium levels checked.

Page last edited: 03 May 2011

References

  1. Drake, M. T. Maurer, M. J. Link, B. K. Habermann, T. M. Ansell, S. M. Micallef, I. N. Kelly, J. L. Macon, W. R. Nowakowski, G. S. Inwards, D. J. Johnston, P. B. Singh, R. J. Allmer, C. Slager, S. L. Weiner, G. J. Witzig, T. E. Cerhan, J. R. Vitamin D insufficiency and prognosis in non-Hodgkin’s lymphoma. J Clin Oncol. 2010 Sep 20; 28 (27): 4191-8.
  2. Lumachi, F. Brunello, A. Roma, A. Basso, U. Cancer-induced hypercalcemia. Anticancer Res. 2009 May; 29 (5): 1551-5.
  3. Sargent, J. T. Smith, O. P. Haematological emergencies managing hypercalcaemia in adults and children with haematological disorders. Br J Haematol. 2010 May; 149 (4): 465-77.
  4. Seymour, J. F. Gagel, R. F. Hagemeister, F. B. Dimopoulos, M. A. Cabanillas, F. Calcitriol production in hypercalcemic and normocalcemic patients with non-Hodgkin lymphoma. Ann Intern Med. 1994 Nov 1; 121 (9): 633-40.
  5. Pecherstorfer, M. Brenner, K. Zojer, N. Current management strategies for hypercalcemia. Treat Endocrinol. 2003; 2 (4): 273-92.
  6. Need, A. G. Horowitz, M. Morris, H. A. Nordin, B. C. Vitamin D status: effects on parathyroid hormone and 1, 25-dihydroxyvitamin D in postmenopausal women. Am J Clin Nutr. 2000 Jun; 71 (6): 1577-81.