Vitamin D insufficiency and prognosis in non-Hodgkin's lymphoma.

Abstract

PURPOSE:

Vitamin D insufficiency is common in the United States, with low levels linked in some studies to higher cancer incidence, including non-Hodgkin's lymphoma (NHL). Recent data also suggest that vitamin D insufficiency is related to inferior prognosis in some cancers, although there are no data for NHL.

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 associations.

CONCLUSION:

25(OH)D insufficiency was associated with inferior EFS and OS in DLBCL and T-cell lymphoma. Whether normalizing vitamin D levels in these patients improves outcomes will require testing in future trials.

• Authors: Matthew T Drake, Matthew J Maurer, Brian K Link, Thomas M Habermann, Stephen M Ansell, Ivana N Micallef, Jennifer L Kelly, William R Macon, Grzegorz S Nowakowski, David J Inwards, Patrick B Johnston, Ravinder J Singh, Cristine Allmer, Susan L Slager, George J Weiner, Thomas E Witzig, James R Cerhan
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 28 Issue 27 Pg. 4191-8 (Sep 20 2010) ISSN: 1527-7755 [Electronic] United States
• PMID: 20713849 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Vitamin D
• 1,25-dihydroxyvitamin D
• 25-hydroxyvitamin D

Topics

• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Chi-Square Distribution
• Chromatography, Liquid
• Disease-Free Survival
• Female
• Humans
• Iowa
• Kaplan-Meier Estimate
• Lymphoma, Non-Hodgkin (blood, complications, mortality, therapy)
• Male
• Middle Aged
• Minnesota
• Proportional Hazards Models
• Prospective Studies
• Risk Assessment
• Risk Factors
• Tandem Mass Spectrometry
• Time Factors
• Treatment Outcome
• Vitamin D (analogs & derivatives, blood)
• Vitamin D Deficiency (blood, complications, mortality)
• Young Adult