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Bartoszewska E, Molik K, Woźniak M, Choromańska A. Telomerase Inhibition in the Treatment of Leukemia: A Comprehensive Review. Antioxidants (Basel) 2024; 13:427. [PMID: 38671875 PMCID: PMC11047729 DOI: 10.3390/antiox13040427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Leukemia, characterized by the uncontrolled proliferation and differentiation blockage of myeloid or lymphoid precursor cells, presents significant therapeutic challenges despite current treatment modalities like chemotherapy and stem cell transplantation. Pursuing novel therapeutic strategies that selectively target leukemic cells is critical for improving patient outcomes. Natural products offer a promising avenue for developing effective chemotherapy and preventive measures against leukemia, providing a rich source of biologically active compounds. Telomerase, a key enzyme involved in chromosome stabilization and mainly active in cancer cells, presents an attractive target for intervention. In this review article, we focus on the anti-leukemic potential of natural substances, emphasizing vitamins (such as A, D, and E) and polyphenols (including curcumin and indole-3-carbinol), which, in combination with telomerase inhibition, demonstrate reduced cytotoxicity compared to conventional chemotherapies. We discuss the role of human telomerase reverse transcriptase (hTERT), particularly its mRNA expression, as a potential therapeutic target, highlighting the promise of natural compounds in leukemia treatment and prevention.
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Affiliation(s)
- Elżbieta Bartoszewska
- Faculty of Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 5, 50-345 Wroclaw, Poland; (E.B.); (K.M.)
| | - Klaudia Molik
- Faculty of Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 5, 50-345 Wroclaw, Poland; (E.B.); (K.M.)
| | - Marta Woźniak
- Department of Clinical and Experimental Pathology, Division of General and Experimental Pathology, Wroclaw Medical University, Marcinkowskiego 1, 50-368 Wroclaw, Poland;
| | - Anna Choromańska
- Department of Molecular and Cellular Biology, Wroclaw Medical University, Borowska 211A, 50-556 Wroclaw, Poland
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Sobhi P, Bahrami M, Mahdizadeh F, Fazaeli A, Babaei G, Rezagholizadeh L. Vitamin D and potential effects on cancers: a review. Mol Biol Rep 2024; 51:190. [PMID: 38270702 DOI: 10.1007/s11033-023-09111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024]
Abstract
Cancer is characterized by the abnormal and uncontrollable division and growth of cells that can infiltrate tissues and alter normal physiological function, which will become crucial and life-threatening if left untreated. Cancer can be a result of genetics, such as mutations or environmental causes, including smoking, lack of physical activity, as well as nutritional imbalance in the body. Vitamin D is one of the foremost nutrients that play a crucial role in a variety of biochemical pathways, and it is an important key factor in several diseases. Vitamin D is an essential nutrient for preventing malignancies and a complementary treatment for cancer through direct and indirect biochemical pathways. In this article, we summarized the correlation between vitamin D and various cancers using an extensive search on PubMed, Google Scholar, and Scopus. This paper reviews the role of vitamin D in different types of cancer.
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Affiliation(s)
- Pouria Sobhi
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Bahrami
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Faraz Mahdizadeh
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Aliakbar Fazaeli
- Department of Biochemistry, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ghader Babaei
- Department of Clinical Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Lotfollah Rezagholizadeh
- Department of Biochemistry, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
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Maha O, Nawal O, Youssef A, Samir B, Hajar M, Noufissa A, Ibtissam EL, Widad R, Rime F, Saloua S, Kaoutar M, Mounia B, Sanae B, Anas O, Latifa L, Laila A, Rim H, Yassine C, Zineb EK, Rhizlane B. Hypovitaminosis D in Haematological Malignancies: Cause or Consequence? Nutr Cancer 2023; 75:1911-1917. [PMID: 37876234 DOI: 10.1080/01635581.2023.2272340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/09/2023] [Indexed: 10/26/2023]
Abstract
Vitamin D is a pleiotropic hormone, widely controversial for its role in the development of chronic diseases and cancers, including haematological malignancies, and also for its impact on overall survival. Observational and interventional studies are being conducted on hypovitaminosis D and haematological malignancies and their subtypes in order to improve the therapeutic management of patients. We carried out a prospective observational study over three years on a population of 251 patients followed up for newly diagnosed haematological malignancies to investigate the impact of vitamin D deficiency on this category of patients. Our population was dominated by the lymphoproliferative syndrome and included 125 patients (49.8%). Anthropometric data showed a significant difference in body mass index between the sexes with a p value of 0.001. Vitamin D levels at diagnosis were inadequate in more than half the patients (56%). This hypovitaminosis was linked to the female sex (p = 0.006), obesity (p = 0.031) and the digestive involvement of the lymphoma (p = 0.03). There was also a relationship between vitamin D deficiency and hypoalbuminemia (p = 0.02). This relationship was confirmed in multivariate analysis, with hypoalbuminemia being a factor associated with the deficiency (p = 0.022, OR = 0.95, IC95% 0.91-0.93). However, we did not find any impact on overall survival.
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Affiliation(s)
- Ouazzani Maha
- Laboratory of Biology and Health, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Oubelkacem Nawal
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Aboussaleh Youssef
- Laboratory of Biology and Health, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Bikri Samir
- Laboratory of Biology and Health, Department of Biology, Faculty of Sciences, Ibn Tofail University, Kenitra, Morocco
| | - Masrour Hajar
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Alami Noufissa
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - El Lahrech Ibtissam
- Faculty of Medicine and Dentistry Fez, Epidemiology Laboratory, Fes, Morocco
| | - Rhandour Widad
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Felk Rime
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Saoudi Saloua
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Meliani Kaoutar
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Bouzayd Mounia
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Bouchnafti Sanae
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Oudrhiri Anas
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Laghrib Latifa
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Aberkane Laila
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Hannini Rim
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Chekkori Yassine
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - El Khammar Zineb
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
| | - Berrady Rhizlane
- Internal Medicine and Onco-Haematology Department, CHU Hassan II Fez, Fes, Morocco
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Nematollahi P, Arabi S, Mansourian M, Yousefian S, Moafi A, Mostafavi SN, Alavi Naeini A, Ebrahimi A, Ebrahimpour K, Amin MM, Kavosh A, Mahmoudi Kohi S, Kelishadi R. Potential role of serum vitamin D as a risk factor in pediatric acute lymphoblastic leukemia. Pediatr Hematol Oncol 2023; 41:54-64. [PMID: 37477214 DOI: 10.1080/08880018.2023.2202687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/10/2023] [Indexed: 07/22/2023]
Abstract
Vitamin D deficiency/insufficiency (VDD, VDI) is common in children yet limited experience exists on the association of VDD and hematologic malignancies amongst this population. Therefore, this study aimed to compare serum vitamin D levels in children with acute lymphoblastic leukemia (ALL) and controls. Moreover, vitamin D levels is compared in subjects with and without relapse and evaluated as a prognostic factor for relapse-free survival (RFS). Children with newly diagnosed ALL were recruited as case group. Data on demographic variables as well as the dietary habits were collected by interview. In addition, serum 25(OH)D3 was measured. The case group was followed up for 36 months to assess RFS. Overall, 358 subjects were included in the study (n = 169 cases, n = 189 controls). The mean levels of 25(OH)D3 were 28.05 ± 18.87 and 28.76 ± 12.99 in cases and controls, respectively (p = .68). VDD was found in 15.4% (n = 26) and 4.2% (n = 8) of the case and control groups, respectively (p < .001). Relapse was seen in 18.34% of patients and vitamin D levels of 20 ng/mL or above were associated with longer RFS (p = .044 by log-rank test). In this study, VDD and VDI amongst children with ALL were significantly higher than controls. In addition, lower levels of Vitamin D were associated with increased risk of relapse.
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Affiliation(s)
- Pardis Nematollahi
- Department of Pathology, School of medicine, Isfahan university of medical sciences, Isfahan, Iran
| | - Sina Arabi
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of epidemiology and Biostatistics, Health school, Isfahan university of medical sciences, Isfahan, Iran
| | - Saeed Yousefian
- Department of pediatrics, School of medicine, Isfahan university of medical sciences, Isfahan, Iran
| | - Alireza Moafi
- Department of pediatrics, School of medicine, Isfahan university of medical sciences, Isfahan, Iran
| | | | - Amirmansour Alavi Naeini
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afshin Ebrahimi
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Ebrahimpour
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mehdi Amin
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aryan Kavosh
- School of medicine, Isfahan university of medical sciences, Isfahan, Iran
| | - Shirin Mahmoudi Kohi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, School of Medicine, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Potre C, Borsi E, Potre O, Ionita I, Samfireag M, Costachescu D, Secosan C, Lazar S, Ristescu AI. A Systematic Review Assessing the Impact of Vitamin D Levels on Adult Patients with Lymphoid Malignancies. Curr Oncol 2023; 30:4351-4364. [PMID: 37185444 PMCID: PMC10137018 DOI: 10.3390/curroncol30040331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/16/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Vitamin D deficiency has been correlated with various conditions, including the risk of developing lymphoid malignancies. This systematic review aimed to assess the association between vitamin D levels at diagnosis of lymphoid malignancies, patient outcomes, and survival. A systematic review was conducted, encompassing 15 studies published until January 2023, involving 4503 patients, examining the relationship between vitamin D and lymphoid cancers. The median age of the patients was 56.5 years, with a median follow-up duration of approximately 36 months across studies. The overall median vitamin D level at initial measurement was 20.4 ng/mL, while a <20 ng/mL threshold was used to define vitamin D insufficiency. The results demonstrated significant associations between vitamin D levels and patient outcomes in several lymphoid malignancies, with a pooled risk in disease progression of 1.93 and a pooled hazard ratio of 2.06 for overall survival in patients with 25-(OH)D levels below the normal threshold of 20 ng/mL. Among findings, it was demonstrated that supplemental vitamin D improves the chemosensitivity of tumors by reducing the rate of tumor growth compared with vitamin D or chemotherapy alone. Vitamin D had a protective effect for patients with DLBCL under R-CHOP treatment, while vitamin D insufficiency was associated with the impairment of rituximab treatment and showed worse clinical outcomes in chimeric antigen receptor T-cell (CAR-T) recipients. Although one study found no association between vitamin D deficiency and the cause of death, most associated vitamin D insufficiency with early clinical failure and lower survival probability. In conclusion, his systematic review highlights the importance of vitamin D levels in the prognosis and survival of patients with lymphoid malignancies. Further research is needed to better understand the underlying mechanisms and explore the potential benefits of vitamin D supplementation in managing these cancers.
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Affiliation(s)
- Cristina Potre
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ema Borsi
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Potre
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ioana Ionita
- Department of Internal Medicine, Discipline of Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Miruna Samfireag
- Department of Internal Medicine, Discipline of Clinical Practical Skills, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Dan Costachescu
- Department of Orthopedics-Traumatology, Urology, Radiology, and Medical Imaging, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Discipline of Obstetrics and Gynecology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Sandra Lazar
- Second Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Anca Irina Ristescu
- Discipline of Anesthesia and Intensive Care, School of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, University Street 16, 700115 Iasi, Romania
- Department of Anesthesia and Intensive Care, Regional Institute of Oncology, General Henri Mathias Berthelot 2-4, 700483 Iasi, Romania
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Ghazaey Zidanloo S, Jahantigh D, Amini N. Vitamin D-Binding Protein and Acute Myeloid Leukemia: A Genetic Association Analysis in Combination with Vitamin D Levels. Nutr Cancer 2023; 75:470-481. [PMID: 36511892 DOI: 10.1080/01635581.2022.2156551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Genetic variations in the vitamin D-binding protein (VDBP) may be associated with the plasma level of serum 25-hydroxyvitamin D. Furthermore, vitamin D deficiency increases the risk of acute myeloid leukemia (AML). This study aimed to examine the potential association of VDBP genetic variants (rs7041 and rs4588) with AML susceptibility. The polymorphisms in the VDBP gene and serum 25-hydroxyvitamin D levels were analyzed in 227 AML patients and 240 healthy controls enrolled in this study. Our data revealed that rs4588 CA and AA genotypes were significantly associated with AML susceptibility (OR = 1.483, p = 0.046; OR = 2.154, p = 0.013, respectively) and also with 61.59% vitamin D deficiency in the total group of AML patients. Under the TG co-dominant and dominant models, however, the rs7041 genotypes were significantly associated with AML protection (OR < 0.6; p < 0.05). In addition, vitamin D deficiency was prevalent in vitamin-D-deficient vs. sufficient AML patients who carried rs7041 and rs4588 mutant alleles (OR ≥ 2.2). Indeed, vitamin D deficiency and its interaction with the genetic variants of VDBP could change the risk of AML. Thus, vitamin D deficiency could be considered an important molecular factor in AML risk assessment.
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Affiliation(s)
| | - Danial Jahantigh
- Department of Biology, Faculty of Science, University of Sistan and Baluchestan, Zahedan, Iran
| | - Nafiseh Amini
- Cancer Molecular Pathology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Andreazzoli F, Bonucci M. Integrative Hematology: State of the Art. Int J Mol Sci 2023; 24:ijms24021732. [PMID: 36675247 PMCID: PMC9864076 DOI: 10.3390/ijms24021732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Blood cancers are a group of diseases with thus far frequently poor prognosis. Although many new drugs, including target therapies, have been developed in recent years, there is still a need to expand our therapeutic armamentarium to better deal with these diseases. Integrative hematology was conceived as a discipline that enriches the patient's therapeutic possibilities with the use of supplements, vitamins and a nutritional approach aiming at improving the response to therapies and the clinical outcome. We will analyze the substances that have proved most useful in preclinical and clinical studies in some of the most frequent blood diseases or in those where these studies are more numerous; the importance of the nutritional approach and the role of the intestinal microbiota will also be emphasized.
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Affiliation(s)
- Francesca Andreazzoli
- Department of Hematology, Versilia’s Hospital, Viale Aurelia, 335, 55049 Camaiore, Italy
- Correspondence:
| | - Massimo Bonucci
- Association for Research on Integrative Oncology Therapies (ARTOI), Via Ludovico Micara, 73, 00165 Rome, Italy
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Xie S, Yu Z, Feng A, Zheng S, Li Y, Zeng Y, Lyu J. Analysis and prediction of relative survival trends in patients with non-Hodgkin lymphoma in the United States using a model-based period analysis method. Front Oncol 2022; 12:942122. [PMID: 36237337 PMCID: PMC9551310 DOI: 10.3389/fonc.2022.942122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/13/2022] [Indexed: 12/24/2022] Open
Abstract
Background Survival rates are usually used to evaluate the effect of cancer treatment and prevention. This study aims to analyze the 5-year relative survival of non-Hodgkin lymphoma (NHL) in United States using population-based cancer registry data. Methods A period analysis was used to evaluate the improvement in long-term prognosis of patients with NHL from 2004 to 2018, and a generalized linear model was developed to predict the 5-year relative survival rates of patients during 2019–2023 based on data from the SEER database stratified by age, sex, race and subtype. Results In this study, relative survival improved for all NHL, although the extent of improvement varied by sex, age group and lymphoma subtype. Survival improvement was also noted for NHL subtypes, although the extent varied, with marginal-zone lymphoma having the highest 5-year relative survival rate (92.5%) followed by follicular lymphoma (91.6%) and chronic lymphocytic leukemia/small lymphocytic lymphoma (87.3%). Across all subtypes, survival rates were slightly higher in females than in males. Survival rates are lower in the elderly than in the young. Furthermore, the study demonstrated that black patients had lower NHL survival rates than white patients. Survival rates for NHL were higher in rural areas than in urban areas. Patients with extra-nodal NHL had a higher survival rate than patients with nodal NHL. Conclusion Overall, patient survival rates for NHL gradually improved during 2004–2018. The trend continues with a survival rate of 75.2% for the period 2019–2023. Analysis by NHL subtype and subgroups indicating that etiology and risk factors may differ by subtype. Identification of population-specific prevention strategies and treatments for each subtype can be aided by understanding these variations.
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Affiliation(s)
- Shuping Xie
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Zhong Yu
- School of Public Health, Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuai Zheng
- School of Public Health, Shaanxi University of Chinese Medicine, Shaanxi, China
| | - Yunmei Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - You Zeng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
- *Correspondence: Jun Lyu,
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Maurya S, Tripathi AK, Verma SP. Preinduction Serum Vitamin D3 Levels and Induction Chemotherapy Remission Rates in Patients with Acute Leukemia. Nutr Cancer 2022; 74:3527-3532. [PMID: 35594251 DOI: 10.1080/01635581.2022.2077389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Vitamin D deficiency(<20 ng/mL) is a common condition, associated with an inferior prognosis in some cancers. However, the prognostic significance of vitamin D deficiency in acute leukemia is largely unknown. The present study aimed to assess the baseline status of vitamin D [25-(OH) D3] and find its association with induction remission rate and mortality using standard chemotherapy in patients with acute leukemia. In this prospective observational study, blood samples were collected from 73 newly diagnosed patients before starting induction chemotherapy to measure serum vitamin D [25(OH)D] levels along with routine investigations.44/73 (60.3%) patients were acute lymphoblastic leukemia (ALL), and 29/77 (39.7%) were acute myeloid leukemia (AML) patients. Descriptive statistics and frequency distribution were used in SPSS software, and Pearson's chi-squared test compared the categorical variables. Post-induction remission status (complete and incomplete remission) and induction-related mortality were correlated with vitamin D levels. 44/73 patients (60.3%) included in this study were males, and the remaining were females. The mean age of the participants was 30.32 ± 14.95 years. The mean serum vitamin D level in the cohort was 15.74 ± 28.14 ng/mL. Vitamin D deficiency was observed in 59/73 (80.8%) patients, whereas 14/73 (19.2%) had normal levels (≥20ng/mL) of the vitamin. Vitamin D deficiency is common among acute leukemia patients. Herein, we observed that low vitamin D level is associated with higher rates of incomplete remission in acute leukemia patients (P = 0.016). Vitamin D deficiency is common among acute leukemia patients and is associated with poor short-term outcomes.
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Affiliation(s)
- Shweta Maurya
- Department of Clinical Hematology, King George's Medical University, Chowk, Lucknow, India
| | - Anil Kumar Tripathi
- Department of Clinical Hematology, King George's Medical University, Chowk, Lucknow, India
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10
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Muchtar E, Drake MT, Leung N, Dispenzieri A, Lacy MQ, Buadi FK, Dingli D, Hayman SR, Kapoor P, Hwa YL, Fonder A, Hobbs M, Gonsalves W, Kourelis TV, Warsame R, Russell S, Go RS, Binder M, Kyle RA, Rajkumar SV, Kumar SK, Gertz MA. Hypovitaminosis D Is Prevalent in Patients With Renal AL Amyloidosis and Associated With Renal Outcome. Front Endocrinol (Lausanne) 2022; 13:891712. [PMID: 35800433 PMCID: PMC9253369 DOI: 10.3389/fendo.2022.891712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Vitamin D deficiency is common, but no data have been reported on vitamin D levels in light chain (AL) amyloidosis. PATIENTS AND METHODS In this exploratory study, stored serum samples from 173 patients with newly diagnosed AL amyloidosis were analyzed for vitamin studies which included 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2D] and vitamin D binding protein (DBP). Measurements were made by liquid chromatography-tandem mass spectrometry. Kidney survival and overall survival (OS) were assessed in association to vitamin D status. RESULTS Cardiac and kidney involvement occurred in 69% and 63% of patients, respectively. 25(OH)D deficiency (<20 ng/mL) was seen in 56.6% of the patients and was notably found among patients with heavy proteinuria (96%), hypoalbuminemia (84.3%) and morbidly obese patients (68.3%). Heavy proteinuria (>5 gr/24-h) and vitamin D supplementation were independent predictors of 25(OH)D level on nominal multivariate regression analysis. 1,25(0H)2D deficiency was noted in 37.6% of patients and was independently associated with low eGFR and hypoalbuminemia. Progression to ESRD occurred in 23.7% of evaluable patients. Patients who progressed to ESRD had lower serum 25(OH)D and 1,25(OH)2D levels compared to those who did not progress to ESRD. On a multivariate analysis, severe 25(OH)D deficiency was an independent predictor of progression to ESRD as was renal stage, while 1,25(OH)2D deficiency was not. CONCLUSIONS Hypovitaminosis D is common in AL amyloidosis, particularly among patients with heavy proteinuria. Severe 25(OH)D deficiency at time of diagnosis predicts progression to ESRD.
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Affiliation(s)
- Eli Muchtar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eli Muchtar,
| | - Matthew T. Drake
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- Department of Endocrinology and Kogod Center of Aging, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Nelson Leung
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | | | - Martha Q. Lacy
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Francis K. Buadi
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - David Dingli
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Prashant Kapoor
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Yi Lisa Hwa
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Amie Fonder
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Miriam Hobbs
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Wilson Gonsalves
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Stephen Russell
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Ronald S. Go
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Moritz Binder
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Robert A. Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | | | - Shaji K. Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
| | - Morie A. Gertz
- Division of Hematology, Mayo Clinic, Rochester, MN, United States
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Impact of vitamin D level at diagnosis and transplantation on the prognosis of hematological malignancy: a meta-analysis. Blood Adv 2021; 6:1499-1511. [PMID: 34496015 PMCID: PMC8905698 DOI: 10.1182/bloodadvances.2021004958] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Vitamin D deficiency impairs prognosis in many types of cancer; however, its significance in each subtype of hematological malignancies is unclear. In addition, data on the association between pretransplant vitamin D levels and outcomes of hematopoietic stem cell transplantation (HSCT) are inconsistent. This systematic review and meta-analysis aimed to elucidate the impact of vitamin D levels at diagnosis or pre-HSCT on the prognosis of hematological malignancies. Thirty articles and abstracts were extracted from PubMed, Embase, and Cochrane Library databases and conference proceedings. Fixed and random effect models were used to analyze primary outcomes: overall survival (OS) and progression-free survival (PFS). Lower vitamin D level was significantly associated with poorer OS and PFS in myeloid malignancies (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.06-1.82 and HR, 2.03; 95% CI, 1.23-3.32, respectively) and lymphoid malignancies (HR, 2.07; 95% CI, 1.79-2.40 and HR, 1.91; 95% CI, 1.61-2.25, respectively), as well as outcomes for several lymphoma subtypes individually. Furthermore, a lower pretransplant vitamin D level was associated with poorer OS in autologous and allogeneic HSCT (HR, 1.65; 95% CI, 1.04-2.61 and HR, 1.50; 95% CI, 1.03-2.18, respectively). Despite the relatively small number of studies evaluated, these data suggest the importance of vitamin D status in outcomes of hematological malignancies (PROSPERO registration number: CRD42020205821).
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12
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Qin JQ, Yin H, Wu JZ, Chen RZ, Xia Y, Wang L, Zhu HY, Fan L, Li JY, Liang JH, Xu W. 25-Hydroxy vitamin D deficiency predicts inferior prognosis in Hodgkin lymphoma. Leuk Res 2021; 105:106580. [PMID: 33836479 DOI: 10.1016/j.leukres.2021.106580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
The study investigated serum 25-Hydroxy vitamin D (25-(OH)D) deficiency and its prognostic values of patients newly diagnosed Hodgkin lymphoma (HL). With seventy-seven patients enrolled, the median level of 25-(OH)D was 44.5 nmol/L (range, 15.5-100.9 nmol/L) and 16 (20.8 %) of them were considered as 25-(OH)D deficiency. With a median follow-up of 28 months (range, 4-56 months), the 2-year progression-free survival (PFS) and overall survival (OS) rate were 75.3 %±5.5 % and 94.7 %±3.0 %, respectively. Patients with deficient 25-(OH)D level had inferior PFS (P<0.001) as well as OS (P<0.001). In multivariate Cox analysis, 25-(OH)D deficiency was observed as an independent prognostic factor for both PFS (hazard ratio (HR) 3.323, 95 % CI 1.527-7.229, P = 0.002) and OS (HR 5.819, 95 % CI 1.322-25.622, P = 0.020). Receiver-operator characteristic (ROC) curve showed International Prognostic Score (IPS) plus 25-(OH)D deficiency (IPS-D) predicted more accurately than IPS in PFS (AUC: 0.735 (95 % CI 0.622-0.829) vs. 0.701 (95 % CI 0.586-0.800), P = 0.033) and OS (AUC: 0.864 (95 % CI 0.767-0.932) vs. 0.825 (95 % CI 0.722-0.902), P = 0.028). All these findings suggest that serum 25-(OH)D level may be an adjunctive indicator to predict prognosis in HL patient.
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Affiliation(s)
- Jia-Qi Qin
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Hua Yin
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Rui-Ze Chen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Yi Xia
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Li Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Hua-Yuan Zhu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Lei Fan
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Jian-Yong Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
| | - Jin-Hua Liang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China.
| | - Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China; Key Laboratory of Hematology of Nanjing Medical University, Nanjing 210029, China; Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China.
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Tao Y, Chen H, Zhou Y, Shi Y. Meta-analysis of the prognostic and clinical value of serum 25-hydroxyvitamin D levels in previously untreated lymphoma. Future Oncol 2021; 17:1825-1838. [PMID: 33728948 DOI: 10.2217/fon-2020-0914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: This meta-analysis explored the prognostic and clinical value of serum 25-hydroxyvitamin D, 25(OH)D, levels in previously untreated lymphoma. Materials & methods: PubMed, Web of Science, Embase and the Cochrane Central Register of Controlled Trials databases were searched for eligible studies. Summary effect estimates and 95% CIs were pooled using random-effects or fixed-effects models. Results: Twelve studies with 4139 patients were included. Low level of serum 25(OH)D was associated with inferior progression-free survival (hazard ratio [HR]: 2.06; 95% CI: 1.82-2.32) and overall survival (HR: 1.94; 95% CI: 1.71-2.19), advanced disease (odds ratio [OR]: 1.52; 95% CI: 1.09-2.13) and elevated lactate dehydrogenase (OR: 1.84; 95% CI: 1.08-3.15). Conclusions: Low level of serum 25(OH)D is a prognostic risk factor for newly diagnosed lymphoma.
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Affiliation(s)
- Yunxia Tao
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Haizhu Chen
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yu Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs. No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
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14
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Thandra KC, Barsouk A, Saginala K, Padala SA, Barsouk A, Rawla P. Epidemiology of Non-Hodgkin's Lymphoma. Med Sci (Basel) 2021; 9:medsci9010005. [PMID: 33573146 PMCID: PMC7930980 DOI: 10.3390/medsci9010005] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022] Open
Abstract
Non-Hodgins’s lymphoma (NHL) is the most common hematological malignancy worldwide, accounting for nearly 3% of cancer diagnoses and deaths. NHL is the seventh most prevalent cancer and has the sixth highest mortality among cancers in the US. NHL accounts for 4% of US cancer diagnoses, and incidence has increased 168% since 1975 (while survival has improved 158%). NHL is more common among men, those >65 years old, and those with autoimmune disease or a family history of hematological malignancies. NHL is a heterogenous disease, with each subtype associated with different risk factors. Marginal zone lymphoma (MZL) is strongly associated with Sjogren’s syndrome (SS) and Hashimoto’s thyroiditis, while peripheral T-cell lymphoma (PTCL) is most associated with celiac disease. Occupational exposures among farm workers or painters increases the risk of most of the common subtypes. Prior radiation treatment, obesity, and smoking are most highly associated with diffuse large B-cell lymphoma (DLBCL), while breast implants have been rarely associated with anaplastic large cell lymphoma (ALCL). Infection with Epstein–Barr Virus (EBV) is strongly associated with endemic Burkitts lymphoma. HIV and human herpes virus 8 (HHV-8), is predisposed to several subtypes of DLBCL, and human T-cell lymphoma virus (HTLV-1) is a causative agent of T-cell lymphomas. Obesity and vitamin D deficiency worsen NHL survival. Atopic diseases and alcohol consumption seem to be protective against NHL.
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Affiliation(s)
- Krishna C. Thandra
- Department of Pulmonary and Critical Care Medicine, Sentara Virginia Beach General Hospital, Virginia Beach, VA 23455, USA
- Correspondence: ; Tel.: +1-757-481-2515
| | - Adam Barsouk
- Sidney Kimmel Cancer Center, Jefferson University, Philadelphia, PA 19107, USA;
| | - Kalyan Saginala
- Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA;
| | - Sandeep Anand Padala
- Department of Medicine, Nephrology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
| | - Alexander Barsouk
- Hematologist-Oncologist, Allegheny Health Network, Pittsburgh, PA 15212, USA;
| | - Prashanth Rawla
- Department of Medicine, Sovah Health, Martinsville, VA 24112, USA;
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15
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Gerousi M, Psomopoulos F, Kotta K, Tsagiopoulou M, Stavroyianni N, Anagnostopoulos A, Anastasiadis A, Gkanidou M, Kotsianidis I, Ntoufa S, Stamatopoulos K. The Calcitriol/Vitamin D Receptor System Regulates Key Immune Signaling Pathways in Chronic Lymphocytic Leukemia. Cancers (Basel) 2021; 13:cancers13020285. [PMID: 33466695 PMCID: PMC7828837 DOI: 10.3390/cancers13020285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Calcitriol, the biologically active form of vitamin D, modulates a plethora of cellular processes following its receptor ligation, namely the vitamin D receptor (VDR). Epidemiological studies have linked low blood levels of vitamin D to adverse disease outcome in several B cell malignancies, including chronic lymphocytic leukemia (CLL), for as yet undetermined reasons. In this study, we sought to obtain deeper biological insight into the role of vitamin D in the pathophysiology of CLL. To this end, we investigated whether the calcitriol/VDR system is functional in CLL and analyzed key signaling pathways that are regulated by calcitriol supplementation, while also exploring the role of microenvironmental signals in the regulation of calcitriol/VDR system. Overall, we provide evidence that the calcitriol/VDR system is functional in CLL, regulating signaling pathways critical for cell survival/proliferation. Although microenvironmental triggers can modulate VDR expression and function, calcitriol appears to act independently, alluding to a potential clinical utility of vitamin D supplementation in CLL. Abstract It has been proposed that vitamin D may play a role in prevention and treatment of cancer while epidemiological studies have linked vitamin D insufficiency to adverse disease outcomes in various B cell malignancies, including chronic lymphocytic leukemia (CLL). In this study, we sought to obtain deeper biological insight into the role of vitamin D and its receptor (VDR) in the pathophysiology of CLL. To this end, we performed expression analysis of the vitamin D pathway molecules; complemented by RNA-Sequencing analysis in primary CLL cells that were treated in vitro with calcitriol, the biologically active form of vitamin D. In addition, we examined calcitriol effects ex vivo in CLL cells cultured in the presence of microenvironmental signals, namely anti-IgM/CD40L, or co-cultured with the supportive HS-5 cells; and, CLL cells from patients under ibrutinib treatment. Our study reports that the calcitriol/VDR system is functional in CLL regulating signaling pathways critical for cell survival and proliferation, including the TLR and PI3K/AKT pathways. Moreover, calcitriol action is likely independent of the microenvironmental signals in CLL, since it was not significantly affected when combined with anti-IgM/CD40L or in the context of the co-culture system. This finding was also supported by our finding of preserved calcitriol signaling capacity in CLL patients under ibrutinib treatment. Overall, our results indicate a relevant biological role for vitamin D in CLL pathophysiology and allude to the potential clinical utility of vitamin D supplementation in patients with CLL.
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Affiliation(s)
- Marina Gerousi
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece; (M.G.); (F.P.); (K.K.); (M.T.); (S.N.)
- Medical Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Fotis Psomopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece; (M.G.); (F.P.); (K.K.); (M.T.); (S.N.)
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17177 Stockholm, Sweden
| | - Konstantia Kotta
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece; (M.G.); (F.P.); (K.K.); (M.T.); (S.N.)
| | - Maria Tsagiopoulou
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece; (M.G.); (F.P.); (K.K.); (M.T.); (S.N.)
| | - Niki Stavroyianni
- Hematology Department and HCT Unit, G. Papanikolaou Hospital, 57010 Thessaloniki, Greece; (N.S.); (A.A.)
| | - Achilles Anagnostopoulos
- Hematology Department and HCT Unit, G. Papanikolaou Hospital, 57010 Thessaloniki, Greece; (N.S.); (A.A.)
| | - Athanasios Anastasiadis
- Blood Transfusion Department, G. Papanikolaou Hospital, 57010 Thessaloniki, Greece; (A.A.); (M.G.)
| | - Maria Gkanidou
- Blood Transfusion Department, G. Papanikolaou Hospital, 57010 Thessaloniki, Greece; (A.A.); (M.G.)
| | - Ioannis Kotsianidis
- Medical Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Stavroula Ntoufa
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece; (M.G.); (F.P.); (K.K.); (M.T.); (S.N.)
| | - Kostas Stamatopoulos
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, 57001 Thessaloniki, Greece; (M.G.); (F.P.); (K.K.); (M.T.); (S.N.)
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17177 Stockholm, Sweden
- Correspondence: ; Tel./Fax: +30-231-049-8271
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16
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Mao J, Yin H, Wang L, Wu JZ, Xia Y, Zhu HY, Fan L, Li JY, Liang JH, Xu W. Prognostic value of 25-hydroxy vitamin D in extranodal NK/T cell lymphoma. Ann Hematol 2020; 100:445-453. [PMID: 33140135 DOI: 10.1007/s00277-020-04320-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
25-hydroxy vitamin D [25-(OH)D] is widely used to determine vitamin D status in clinic. The aim of our study was to evaluate the prognostic value of 25-(OH)D in extranodal NK/T cell lymphoma (ENKTL). Ninety-three (93) ENKTL patients with available serum 25-(OH)D values were enrolled in our study. Vitamin D deficiency is defined as a 25-(OH)D below 50 nmol/L (20 ng/ml). Univariate and multivariate regression analyses were performed to determine independent risk factors for progression-free survival (PFS) and overall survival (OS). Receiver operator characteristic (ROC) curves were plotted, and corresponding areas under the curves (AUC) were calculated to estimate the accuracy of PINK-E (prognostic index of natural killer lymphoma added with Epstein-Barr virus-DNA status) and 25-(OH)D deficiency in ENKTL risk-stratification. Our results suggested that the vitamin D deficiency was an independent inferior prognostic factor for both PFS [hazard ratio (HR), 2.869; 95% confidence interval (CI), 1.540 to 5.346; P = 0.003] and OS (HR, 3.204; 95% CI, 1.559 to 6.583; P = 0.006) in patients with ENKTL. Additionally, we demonstrated that adding 25-(OH)D deficiency to PINK-E score system indeed has a superior prognostic significance than PINK-E alone for PFS [AUC: 0.796 (95% CI: 0.699 to 0.872) vs. 0.759 (95% CI: 0.659 to 0.841), P = 0.020] and OS [AUC: 0.755 (95% CI: 0.655 to 0.838) vs. 0.721 (95% CI: 0.618 to 0.809), P = 0.040]. In conclusion, our study proved that 25-(OH)D deficiency was associated with inferior survival outcome of ENKTL patients.
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Affiliation(s)
- Jin Mao
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua Yin
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jia-Zhu Wu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Yi Xia
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Hua-Yuan Zhu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Lei Fan
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jian-Yong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China
| | - Jin-Hua Liang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China.
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, 210029, China.
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, 210029, China.
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A carotenoid-enriched extract from pumpkin delays cell proliferation in a human chronic lymphocytic leukemia cell line through the modulation of autophagic flux. CURRENT RESEARCH IN BIOTECHNOLOGY 2020. [DOI: 10.1016/j.crbiot.2020.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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18
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Emerging Role of Integrative Medicine in Hematologic Malignancies: a Literature Review and Update on Current Trends in Complementary Medical Practices in Hematologic Cancers. Curr Hematol Malig Rep 2020; 14:328-336. [PMID: 31209644 DOI: 10.1007/s11899-019-00526-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review discusses the emerging role of integrative hematology. It reinforces the growing interest of CAM among patients, and the importance of provider knowledge and participation in discussions with patients about the subject. The main question asked in this review, "Is there evidence for the use of integrative medicine practices in the field of malignant hematology?" is answered by examining current research and providing relevant summaries. RECENT FINDINGS Data suggests that practices such as meditative movement, exercise, nutrition and supplements and touch therapy can be used for symptom alleviation, preventive measures, and novel treatment development. Integrative hematology is a needed part of complete patient care, and it is the role of providers to be knowledgeable and open to ensure patients are engaging in practices that are evidence-informed and safe. More studies are needed in the field in order to make concrete and robust recommendations.
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Eicher F, Mansouri Taleghani B, Schild C, Bacher U, Pabst T. Reduced survival after autologous stem cell transplantation in myeloma and lymphoma patients with low vitamin D serum levels. Hematol Oncol 2020; 38:523-530. [PMID: 32594534 DOI: 10.1002/hon.2774] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/27/2020] [Accepted: 06/23/2020] [Indexed: 12/31/2022]
Abstract
High-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) is applied for consolidation in myeloma and relapsing lymphoma patients. Vitamin D (VitD) exerts effects during hematopoietic stem cell proliferation, differentiation and interactions with the immune system. VitD deficiency is frequent in patients with hematological malignancies, but its prognostic relevance after ASCT remains unclear. We investigated the effect of VitD serum levels in patients with lymphomas and myeloma at ASCT on progression-free (PFS) and overall survival (OS). The cohort (n = 183) was divided into two groups: 81 (44%) had VitD levels >52 nmol/L and 102 (56%) ≤52 nmol/L at ASCT. VitD levels >52 nmol/L were associated with better PFS (P = 0.0194) and OS (P = 0.011). Similarly, when evaluating myeloma patients alone, patients with lower VitD levels (≤52 nmol/L) had inferior PFS (P = 0.0412) and OS (P = 0.049). Finally, the multivariate analysis was consistent that varying VitD levels were significantly associated with OS (P = 0.0167), also when stratifying patients in groups with VitD levels > versus ≤52 nmol/L (P = 0.0421). Our data suggest that reduced serum VitD levels in myeloma and lymphoma patients undergoing HDCT/ASCT are associated with inferior outcome. Optimizing VitD levels before ASCT may be warranted.
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Affiliation(s)
- Florian Eicher
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | | | - Christof Schild
- Department of Clinical Chemistry, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Ulrike Bacher
- Department of Hematology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Pabst
- Department of Medical Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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20
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Soto JR, Anthias C, Madrigal A, Snowden JA. Insights Into the Role of Vitamin D as a Biomarker in Stem Cell Transplantation. Front Immunol 2020; 11:966. [PMID: 32582151 PMCID: PMC7295104 DOI: 10.3389/fimmu.2020.00966] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
Vitamin D was discovered 100 years ago and since then multiple studies have consistently proved its effect on bone health and mineral metabolism. Further research has also explored its so-called "non-classical" biological effects, encompassing immune regulation and control of cell proliferation and differentiation. Vitamin D downregulates pro-inflammatory immune cells and subsequently their cytokine production, while enhancing the anti-inflammatory subsets, thus mediating inflammation and fostering a more tolerogenic environment. Its biological action is exerted through the vitamin D receptor, a nuclear receptor that mediates gene transcription and is expressed in most cells from the innate and adaptive immunity. Owing to its immune-modulatory properties, its role in cancer pathophysiology, hematology disorders and stem cell transplantation has also been investigated. Vitamin D deficiency causes immune imbalance and cytokine dysregulation, contributing to some autoimmune diseases. In the hematopoietic stem cell transplant setting this could lead to complications such as acute and chronic graft-versus-host disease, ultimately impacting transplant outcomes. Other factors have also been linked to this, including specific polymorphisms of the vitamin D receptor in both stem cell donors and recipients. Nevertheless, studies thus far have shown conflicting results and the use of vitamin D or its receptor as biomarkers has not been validated yet, therefore there are no evidence-based consensus guidelines to guide clinicians in their day-to-day practice. To gain more insight in this topic, we have reviewed the existent literature and gathered the current evidence. This is an overview of the role of serum vitamin D and its receptor as biomarkers for clinical outcomes in patients undergoing hematopoietic stem cell transplantation. Further prospective studies with larger cohorts are warranted to validate the viability of using serum vitamin D, and its receptor, as biomarkers in potential stem cell donors and patients, to identify those at risk of post-transplant complications and enable early therapeutic interventions.
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Affiliation(s)
- Jose Ros Soto
- Anthony Nolan Research Institute, Royal Free Hospital and University College London, London, United Kingdom
| | - Chloe Anthias
- Anthony Nolan Research Institute, Royal Free Hospital and University College London, London, United Kingdom
- Department of Haemato-Oncology, The Royal Marsden Hospital, Sutton, United Kingdom
| | - Alejandro Madrigal
- Anthony Nolan Research Institute, Royal Free Hospital and University College London, London, United Kingdom
| | - John A. Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Bioavailable 25(OH)D level is associated with clinical outcomes of patients with diffuse large B-cell lymphoma: An exploratory study. Clin Nutr 2020; 40:157-165. [PMID: 32446789 DOI: 10.1016/j.clnu.2020.04.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/02/2020] [Accepted: 04/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUNDS & AIMS Vitamin D insufficiency is associated with worse clinical outcomes in multiple cancer types; however, its roles in diffuse large B-cell lymphoma (DLBCL) patients are still unclear. Here, we aimed to determine the prognostic values of circulating total 25(OH)D and bioavailable 25(OH)D levels in DLBCL patients. METHODS A total of 332 newly diagnosed DLBCL patients were recruited. The plasma total 25(OH)D and bioavailable 25(OH)D levels at diagnosis were determined, and their associations with the clinical characteristics and the prognosis of patients were evaluated. The predictive values of clinical characteristics and 25(OH)D levels in the responses to R-CHOP treatments in DLBCL patients were also assessed. RESULTS Of the patients, 92.8% had insufficient vitamin D status (<30 ng/mL). Patients with higher plasma bioavailable 25(OH)D were associated with better progression-free survival (PFS, multivariate adjusted-HR = 0.72, 95% CI = 0.38-1.35, P = 0.301, Tertile 2 vs. 1; multivariate adjusted-HR = 0.39, 95% CI = 0.20-0.79, P = 0.009, Tertile 3 vs. 1) and overall survival (OS, multivariate adjusted-HR = 0.89, 95% CI = 0.39-2.02, P = 0.777, Tertile 2 vs. 1; multivariate adjusted-HR = 0.21, 95% CI = 0.07-0.65, P = 0.007, Tertile 3 vs. 1). Meanwhile, higher plasma total 25(OH)D level was significantly associated with better PFS but not OS in DLBCL patients. Besides, DLBCL patients with higher total or bioavailable 25(OH)D levels were more sensitive to the R-CHOP regimen treatments. CONCLUSION The bioavailable 25(OH)D level may serve as a novel prognostic biomarker in DLBCL patients.
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To D or not to D: vitamin D in hematopoietic cell transplantation. Bone Marrow Transplant 2020; 55:2060-2070. [PMID: 32335583 DOI: 10.1038/s41409-020-0904-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
Vitamin D plays an essential role in bone health, immune tolerance, and immune modulation. Autologous and allogeneic hematopoietic cell transplantation (HCT) recipients are at increased risk of vitamin D deficiency, which may increase risks of bone loss and fracture, graft-versus-host disease (GVHD), and relapse, and can delay hematologic and immune recovery following HCT. Growing evidence indicates that vitamin D may have a role as an immunomodulator, and supplementation during HCT may decrease the risk of GVHD, infection, relapse, and mortality. In this paper, we review the role of vitamin D and its association with HCT outcomes and discuss prevention and treatment of vitamin D deficiency after HCT in adult recipients. We review the role of monitoring of vitamin D levels pre- and post-HCT and its supplementation in appropriate patients. We also review the use of bone densitometry prior to HCT and in long-term follow-up and the treatment of osteoporosis in this high-risk population.
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Cohen JA, Bomben R, Pozzo F, Tissino E, Härzschel A, Hartmann TN, Zucchetto A, Gattei V. An Updated Perspective on Current Prognostic and Predictive Biomarkers in Chronic Lymphocytic Leukemia in the Context of Chemoimmunotherapy and Novel Targeted Therapy. Cancers (Basel) 2020; 12:cancers12040894. [PMID: 32272636 PMCID: PMC7226446 DOI: 10.3390/cancers12040894] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 01/04/2023] Open
Abstract
Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with a variable clinical course. Novel biomarkers discovered over the past 20 years have revolutionized the way clinicians approach prognostication and treatment especially in the chemotherapy-free era. Herein, we review the best established prognostic and predictive biomarkers in the setting of chemoimmunotherapy (CIT) and novel targeted therapy. We propose that TP53 disruption (defined as either TP53 mutation or chromosome 17p deletion), unmutated immunoglobulin heavy chain variable region gene status (UM IGHV), NOTCH1 mutation, and CD49d expression are the strongest prognosticators of disease progression and overall survival in the field of novel biomarkers including recurrent gene mutations. We also highlight the predictive role of TP53 disruption, UM IGHV, and NOTCH1 mutation in the setting of CIT and TP53 disruption and CD49d expression in the setting of novel targeted therapy employing B-cell receptor (BCR) and B-cell lymphoma-2 (BCL2) inhibition. Finally, we discuss future directions in the field of biomarker development to identify those with relapsed/refractory disease at risk for progression despite treatment with novel therapies.
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Affiliation(s)
- Jared A. Cohen
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, Italy (R.B.); (F.P.); (E.T.); (V.G.)
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, Italy (R.B.); (F.P.); (E.T.); (V.G.)
| | - Federico Pozzo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, Italy (R.B.); (F.P.); (E.T.); (V.G.)
| | - Erika Tissino
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, Italy (R.B.); (F.P.); (E.T.); (V.G.)
| | - Andrea Härzschel
- Department of Internal Medicine I, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (A.H.); (T.N.H.)
| | - Tanja Nicole Hartmann
- Department of Internal Medicine I, Medical Center and Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany; (A.H.); (T.N.H.)
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, Italy (R.B.); (F.P.); (E.T.); (V.G.)
- Correspondence: ; Tel.: +39-0434-659720; Fax: +39-0434-659409
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081 Aviano, Italy (R.B.); (F.P.); (E.T.); (V.G.)
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Jackmann N, Mäkitie O, Harila-Saari A, Gustafsson J, Nezirevic Dernroth D, Frisk P. Vitamin D status in children with leukemia, its predictors, and association with outcome. Pediatr Blood Cancer 2020; 67:e28163. [PMID: 31925904 DOI: 10.1002/pbc.28163] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Children and adolescents with leukemia are potentially at high risk of vitamin D inadequacy, which may have clinical relevance for skeletal morbidity, infections, and cancer outcome. This study aimed to evaluate vitamin D status at the time of diagnosis to investigate its predictors and association with overall survival in children with leukemia. PROCEDURE We included all 295 children and adolescents diagnosed with leukemia at our institution between 1990 and 2016 who had available serum sample from the time of diagnosis. We analyzed serum 25-hydroxyvitamin D and parathyroid hormone levels and correlated them with clinical data. RESULTS The 25-hydroxyvitamin D level was deficient (< 25 nmol/L), insufficient (25-50 nmol/L), sufficient (50-75 nmol/L), and optimal (> 75 nmol/L) in 6.4%, 26.8%, 39.7%, and 27.1% of the children, respectively. Older age and a more recent time of sampling (calendar year) predicted lower 25-hydroxyvitamin D level. In preschool children (age ≤6 years), lower 25-hydroxyvitamin D level was also associated with acute myeloid leukemia, and a 25-hydroxyvitamin D level < 50 nmol/L was associated with inferior overall survival. In school-aged children (age > 6 years), the 25-hydroxyvitamin D level showed significant seasonal variation. CONCLUSION It remains unclear whether vitamin D supplementation in pediatric leukemia patients will improve outcome.
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Affiliation(s)
- Natalja Jackmann
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
| | - Outi Mäkitie
- Department of Molecular Medicine and Surgery, Karolinska Institute, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Arja Harila-Saari
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
| | - Jan Gustafsson
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
| | - Dzeneta Nezirevic Dernroth
- Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Frisk
- Department of Women's and Children's Health, University Children's Hospital, Uppsala, Sweden
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Role of Vitamins A and D in BCR-ABL Arf -/- Acute Lymphoblastic Leukemia. Sci Rep 2020; 10:2359. [PMID: 32047189 PMCID: PMC7012907 DOI: 10.1038/s41598-020-59101-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/21/2020] [Indexed: 02/07/2023] Open
Abstract
The effects of vitamin A and/or vitamin D deficiency were studied in an Arf−/− BCR-ABL acute lymphoblastic leukemia murine model. Vitamin D sufficient mice died earlier (p = 0.003) compared to vitamin D deficient (VDD) mice. Vitamin A deficient (VAD) mice fared worst with more rapid disease progression and decreased survival. Mice deficient for vitamins A and D (VADD) had disease progression similar to VAD mice. Regulatory T cells, previously shown to associate with poor BCR-ABL leukemia control, were present at higher frequencies among CD4+ splenocytes of vitamin A deficient vs. sufficient mice. In vitro studies demonstrated 1,25-dihydroxyvitamin D (1,25(OH)2VD3) increased the number of BCR-ABL ALL cells only when co-cultured with bone marrow stroma. 1,25(OH)2VD3 induced CXCL12 expression in vivo and in vitro in stromal cells and CXCL12 increased stromal migration and the number of BCR-ABL blasts. Vitamin D plus leukemia reprogrammed the marrow increasing production of collagens, potentially trapping ALL blasts. Vitamin A (all trans retinoic acid, ATRA) treated leukemic cells had increased apoptosis, decreased cells in S-phase, and increased cells in G0/G1. ATRA signaled through the retinoid X receptor to decrease BCR-ABL leukemic cell viability. In conclusion, vitamin A and D deficiencies have opposing effects on mouse survival from BCR-ABL ALL.
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Xu DM, Liang JH, Wang L, Zhu HY, Xia Y, Fan L, Li JY, Xu W. 25-Hydroxy vitamin D deficiency predicts inferior prognosis in mantle cell lymphoma. J Cancer Res Clin Oncol 2020; 146:1003-1009. [DOI: 10.1007/s00432-020-03125-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
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Flamann C, Peter K, Kreutz M, Bruns H. Regulation of the Immune Balance During Allogeneic Hematopoietic Stem Cell Transplantation by Vitamin D. Front Immunol 2019; 10:2586. [PMID: 31749811 PMCID: PMC6848223 DOI: 10.3389/fimmu.2019.02586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/18/2019] [Indexed: 12/14/2022] Open
Abstract
One of the most promising therapeutic approaches for numerous hematological malignancies represents the allogeneic hematopoietic stem cell transplantation (allo-HSCT). One major complication is the development of the life-threatening graft-vs.-host disease (GvHD) which limits beneficial effects of graft-vs.-leukemia (GvL) responses during allo-HSCT. Strengthening GvL effects without induction of severe GvHD is essential to decrease the relapse rate after allo-HSCT. An interesting player in this context is vitamin D3 since it has modulatory capacity in both preventing GvHD and boosting GvL responses. Current studies claim that vitamin D3 induces an immunosuppressive environment by dendritic cell (DC)-dependent generation of regulatory T cells (Tregs). Since vitamin D3 is known to support the antimicrobial defense by re-establishing the physical barrier as well as releasing defensins and antimicrobial peptides, it might also improve graft-vs.-infection (GvI) effects in patients. Beyond that, alloreactive T cells might be attenuated by vitamin D3-mediated inhibition of proliferation and activation. Despite the inhibitory effects of vitamin D3 on T cells, anti-tumor responses of GvL might be reinforced by vitamin D3-triggered phagocytic activity and antibody-based immunotherapy. Therefore, vitamin D3 treatment does not only lead to a shift from a pro-inflammatory toward a tolerogenic state but also promotes tumoricidal activity of immune cells. In this review we focus on vitamin D3 and its immunomodulatory effects by enhancing anti-tumor activity while alleviating harmful allogeneic responses in order to restore the immune balance.
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Affiliation(s)
- Cindy Flamann
- Department of Internal Medicine 5, Hematology/Oncology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Katrin Peter
- Department of Internal Medicine III - Hematology and Internal Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Marina Kreutz
- Department of Internal Medicine III - Hematology and Internal Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Heiko Bruns
- Department of Internal Medicine 5, Hematology/Oncology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Borchmann S, Cirillo M, Goergen H, Meder L, Sasse S, Kreissl S, Bröckelmann PJ, von Tresckow B, Fuchs M, Ullrich RT, Engert A. Pretreatment Vitamin D Deficiency Is Associated With Impaired Progression-Free and Overall Survival in Hodgkin Lymphoma. J Clin Oncol 2019; 37:3528-3537. [PMID: 31622132 DOI: 10.1200/jco.19.00985] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Vitamin D deficiency is described as a modifiable risk factor for the incidence of and mortality in many common cancers; however, data in Hodgkin lymphoma (HL) are lacking. PATIENTS AND METHODS We thus performed a study measuring pretreatment vitamin D levels in prospectively treated patients with HL and correlated this with clinical outcomes. A total of 351 patients from the German Hodgkin Study Group clinical trials (HD7, HD8, and HD9) were included. RESULTS Fifty percent of patients were vitamin D deficient (< 30 nmol/L) before planned chemotherapy. Pretreatment vitamin D deficiency was more common in relapsed/refractory patients than matched relapse-free controls (median baseline vitamin D, 21.4 nmol/L v 35.5 nmol/L; proportion with vitamin D deficiency, 68% v 41%; P < .001). Vitamin D-deficient patients had impaired progression-free survival (10-year difference, 17.6%; 95% CI, 6.9% to 28.4%; hazard ratio, 2.13; 95% CI, 1.84 to 2.48; P < .001) and overall survival (10-year difference, 11.1%; 95% CI, 2.1% to 20.2%; hazard ratio, 1.82; 95% CI, 1.53 to 2.15; P < .001), consistent across trials and treatment groups. We demonstrated that vitamin D status is an independent predictor of outcome and hypothesized that vitamin D status might be important for the chemosensitivity of HL. We subsequently performed experiments supplementing physiologic doses of vitamin D (calcitriol) to cultured HL cell lines and demonstrated increased antiproliferative effects in combination with chemotherapy. In an HL-xenograft animal model, we showed that supplemental vitamin D (dietary supplement, cholecalciferol) improves the chemosensitivity of tumors by reducing the rate of tumor growth compared with vitamin D or chemotherapy alone. CONCLUSION On the basis of our clinical and preclinical findings, we encourage that vitamin D screening and replacement be incorporated into future randomized clinical trials to properly clarify the role of vitamin D replacement therapy in HL.
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Affiliation(s)
- Sven Borchmann
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Center for Molecular Medicine, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Else Kröner Forschungskolleg Clonal Evolution in Cancer, Cologne, Germany
| | - Melita Cirillo
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Helen Goergen
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Lydia Meder
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Center for Molecular Medicine, Cologne, Germany
| | - Stephanie Sasse
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Stefanie Kreissl
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Paul Jan Bröckelmann
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Bastian von Tresckow
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Michael Fuchs
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
| | - Roland Tillmann Ullrich
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital of Cologne, Center for Molecular Medicine, Cologne, Germany
| | - Andreas Engert
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, German Hodgkin Study Group, Cologne, Germany
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Pophali PA, Ip A, Larson MC, Rosenthal AC, Maurer MJ, Flowers CR, Link BK, Farooq U, Feldman AL, Allmer C, Slager SL, Witzig TE, Habermann TM, Cohen JB, Cerhan JR, Thompson CA. The association of physical activity before and after lymphoma diagnosis with survival outcomes. Am J Hematol 2018; 93:1543-1550. [PMID: 30230581 PMCID: PMC6386179 DOI: 10.1002/ajh.25288] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
The impact of physical activity (PA) on lymphoma survival is not known. The association of PA and change in PA with overall (OS), lymphoma-specific (LSS) and event-free (EFS) survival was evaluated in a prospective cohort of newly diagnosed lymphoma patients (2002-2012). We calculated Leisure Score Indexes (mLSI) from the self-reported usual adult PA (baseline) and at 3-years post-diagnosis (FU3), grouping patients by active vs insufficiently active by the American Cancer Society PA guidelines. Associations of PA with survival were assessed using hazard ratios (HRs) and 95% confidence intervals (CI) from Cox models stratified by lymphoma subtype, adjusted for age, sex, baseline BMI, and comorbidity score with change scores further adjusted for baseline PA. Three thousand sixty participants were evaluable at baseline and 1371 at FU3. Active patients had superior survival from baseline [HR (CI): OS 0.82 (0.72-0.94); LSS 0.74 (0.61-0.90); EFS 0.92 (0.82-1.02)] and FU3 [HR (CI): OS 0.64 (0.46-0.88); LSS 0.32 (0.18-0.59); EFS 0.82 (0.61-1.10)] compared to insufficiently active. An increase in mLSI from baseline to FU3 (vs stable mLSI) was associated with superior OS (HR = 0.70, CI 0.49-1.00) and LSS (HR = 0.49, CI 0.26-0.94).The continuous change in mLSI at FU3 was significantly associated with OS, LSS and EFS; maintained across subgroups and appeared linear. Higher PA among lymphoma patients at diagnosis and 3 years is significantly associated with OS, LSS, and EFS. Increasing PA after diagnosis is significantly associated with improved OS and LSS supporting an important role for PA in lymphoma survivorship and the need for intervention trials.
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Affiliation(s)
- Priyanka A. Pophali
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Andrew Ip
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | | | - Allison C. Rosenthal
- Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ
| | | | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Brian K. Link
- Division of Hematology, Oncology and Bone and Marrow Transplantation, University of Iowa, Iowa City, IO
| | - Umar Farooq
- Division of Hematology, Oncology and Bone and Marrow Transplantation, University of Iowa, Iowa City, IO
| | - Andrew L. Feldman
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Susan L. Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Thomas E. Witzig
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Thomas M. Habermann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jonathon B. Cohen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - James R. Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Carrie A. Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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30
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Vitamin D: is it important in haematopoietic stem cell transplantation? A review. Bone Marrow Transplant 2018; 54:810-820. [PMID: 30401967 DOI: 10.1038/s41409-018-0377-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/28/2018] [Accepted: 10/12/2018] [Indexed: 12/17/2022]
Abstract
Vitamin D has effects on several body systems, from well-established role in bone metabolism to emerging effects on the immune system. Increasing evidence supports an immunomodulatory effect including inhibition of the pro-inflammatory lymphocyte subsets while enhancing their anti-inflammatory counterpart, in favour of a more tolerogenic status. Vitamin D deficiency is increasingly recognised in association with autoimmune and inflammatory diseases, also with evidence from the field of asthma where vitamin D supplementation may overcome steroid resistance. In the HSCT setting, vitamin D deficiency has been variably associated with increased complications, including graft-versus-host disease (GvHD), with a potential impact on survival outcomes. In this review we provide an overview and critical appraisal of the current literature of the role of vitamin D (and its deficiency) in relation to immunity in both allogeneic and autologous HSCT settings. We conclude that the evidence base is mixed, but a greater understanding of the role of vitamin D in relation to immune reconstitution following HSCT is warranted. Given its potential benefits, its inexpensive cost and favourable side effect profile, consideration of vitamin D levels and its supplementation could be easily incorporated into prospective studies in GvHD, including clinical trials of novel therapeutics, supportive care and biomarkers.
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31
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Pezeshki SMS, Asnafi AA, Khosravi A, Shahjahani M, Azizidoost S, Shahrabi S. Vitamin D and its receptor polymorphisms: New possible prognostic biomarkers in leukemias. Oncol Rev 2018; 12:366. [PMID: 30405894 PMCID: PMC6199555 DOI: 10.4081/oncol.2018.366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/13/2018] [Indexed: 12/28/2022] Open
Abstract
Several factors such as chromosomal translocations, gene mutations, and polymorphisms are involved in the pathogenesis of leukemia/lymphoma. Recently, the role of vitamin D (VD) and vitamin D receptor (VDR) polymorphisms in hematologic malignancies has been considered. In this review, we examine the possible role of VD levels, as well as VDR polymorphisms as prognostic biomarkers in leukemia/lymphoma. Relevant English language literature were searched and retrieved from Google Scholar search engine (1985-2017). The following keywords were used: vitamin D, vitamin D receptor, leukemia, lymphoma, and polymorphism. Increased serum levels of VD in patients with leukemia are associated with a better prognosis. However, low VD levels are associated with a poor prognosis, and VDR polymorphisms in various leukemias can have prognostic value. VD biomarker can be regarded as a potential prognostic factor for a number of leukemias, including acute myeloblastic leukemia (AML), chronic lymphoblastic leukemia (CLL), and diffuse large B-cell lymphoma (DLBCL). There is a significant relationship between different polymorphisms of VDR (including Taq I and Fok I) with several leukemia types such as ALL and AML, which may have prognostic value.
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Affiliation(s)
- Seyed Mohammad Sadegh Pezeshki
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Amin Asnafi
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Khosravi
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Shahjahani
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shirin Azizidoost
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeid Shahrabi
- Department of Biochemistry and Hematology, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Relationship between serum 25-hydroxyvitamin D and red blood cell indices in German adolescents. Eur J Pediatr 2018; 177:583-591. [PMID: 29387981 DOI: 10.1007/s00431-018-3092-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
UNLABELLED Since the impact of vitamin D on red blood cell formation has not been well studied, we aimed at assessing the putative link between serum 25-hydroxyvitamin D (25[OH]D) concentrations and hematological markers of erythropoiesis in a large cohort of German adolescents aged 11 to 17 years. In total, 5066 participants from the population-based, nationally representative KiGGS study (Kinder- und Jugendgesundheitssurvey, German Health Interview and Examination Survey for Children and Adolescents) were grouped into either tertiles or clinically accepted cutoff levels for serum 25(OH)D. Results demonstrated significant and inverse correlations between 25(OH)D levels and several hematological parameters including hemoglobin concentration (r = - 0.04, p = 0.003), mean corpuscular hemoglobin (r = - 0.11, p < 0.001), red blood cell count (r = - 0.04, p = 0.002), and soluble transferrin receptor (r = - 0.1, p < 0.001), whereas, in contrast, serum 25(OH)D was positively correlated to the mean corpuscular volume of erythrocytes (r = 0.08, p < 0.001). Multinomial regression models adjusted for clinically relevant confounders confirmed statistically significant differences between the two strata of 25(OH)D groups with respect to red blood cell markers (hemoglobin concentration, red blood cell count, mean corpuscular volume, and corpuscular hemoglobin, as well as iron and soluble transferrin receptor). CONCLUSIONS The link between serum 25(OH)D and several important hematological parameters may point to an inhibitory role of vitamin D in the regulation of erythropoiesis in adolescents. What is Known: • The physiological effects of vitamin D on calcium homeostasis and bone metabolism have been established. • However, much less is known about the impact of circulating vitamin D on erythropoiesis. What is New: • Data from the KiGGS study in German adolescents demonstrated significant associations between serum vitamin D concentrations and red blood cell indices. • Further studies should be conducted to decipher the underlying mechanisms of vitamin D on erythropoiesis.
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25(OH) vitamin D deficiency in lymphoid malignancies, its prevalence and significance. Are we fully aware of it? Support Care Cancer 2018; 26:2825-2832. [DOI: 10.1007/s00520-018-4101-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/07/2018] [Indexed: 12/22/2022]
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Haskin G, Kogan M. Case Report of Unexpectedly Long Survival of Patient With Chronic Lymphocytic Leukemia: Why Integrative Methods Matter. Integr Med (Encinitas) 2018; 17:51-56. [PMID: 30962776 PMCID: PMC6380985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Chronic lymphocytic leukemia (CLL) is one of the most common types of leukemia. In the present case, an evidence-guided treatment plan of supplements and lifestyle changes were used to support the patient. CASE PRESENTATION A 56-y-old female presented to her primary care physician for a routine physical in 2001. Complete blood cell results suggest pathology among white blood cells. Flow cytometry was used to confirm the presence of CLL. Other than an episode of splenomegaly in 2005 and mild lymphadenopathy, the patient has remained asymptomatic since diagnosis in 2001. In late 2001, the patient began a physician-assisted regimen of alternative dietary supplements and lifestyle changes. CONCLUSION Nutritional supplementation along with lifestyle changes appears to have supported the maintenance of stable and indolent CLL in this patient. It is important for physicians to be prepared to engage with their patients on use of supplements and lifestyle changes in managing their disease.
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Affiliation(s)
| | - Mikhail Kogan
- Corresponding author: Mikhail Kogan, MD E-mail address:
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Cerhan JR, Link BK, Habermann TM, Maurer MJ, Feldman AL, Syrbu SI, Thompson CA, Farooq U, Novak AJ, Slager SL, Allmer C, Lunde JJ, Macon WR, Inwards DJ, Johnston PB, Micallef INM, Nowakowski GS, Ansell SM, Kay NE, Weiner GJ, Witzig TE. Cohort Profile: The Lymphoma Specialized Program of Research Excellence (SPORE) Molecular Epidemiology Resource (MER) Cohort Study. Int J Epidemiol 2017; 46:1753-1754i. [PMID: 29025017 PMCID: PMC5837578 DOI: 10.1093/ije/dyx119] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/04/2017] [Accepted: 06/12/2017] [Indexed: 01/13/2023] Open
Affiliation(s)
- James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Brian K Link
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Matthew J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Feldman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA and
| | - Sergei I Syrbu
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Umar Farooq
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Susan L Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cristine Allmer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Julianne J Lunde
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - William R Macon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA and
| | | | | | | | | | | | | | - George J Weiner
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Borchmann S, Müller H, Engert A. Hodgkin Lymphoma has a seasonal pattern of incidence and mortality that depends on latitude. Sci Rep 2017; 7:14903. [PMID: 29097683 PMCID: PMC5668282 DOI: 10.1038/s41598-017-14805-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/03/2017] [Indexed: 12/26/2022] Open
Abstract
Seasonal variations in incidence and mortality after a Hodgkin lymphoma (HL) diagnosis have been previously described with partly conflicting results. The goal of this analysis is to provide a comprehensive analysis of these seasonal variations. In total, 41,405 HL cases diagnosed between 1973 and 2012 in the 18 Surveillance, Epidemiology, and End Results registries were included. Cosinor analysis and Cox proportional-hazards models were employed to analyze seasonality of incidence and mortality, respectively. HL shows a sinusoid seasonal incidence pattern (p < 0.001). Estimated incidence in March is 15.4% [95%-CI: 10.8-20.0] higher than in September. This sinusoid pattern is more pronounced at higher latitudes (p = 0.023). The risk of dying within the first three years after a HL diagnosis in winter is significantly increased compared to a HL diagnosis in summer at higher latitudes (HR = 1.082 [95%-CI: 1.009-1.161], p = 0.027). Furthermore, increasing northern latitude increases the additional mortality risk conferred by a diagnosis in winter (pinteraction0.033). The seasonality patterns presented here provide epidemiological evidence that Vitamin D might play a protective role in HL. Further evidence on the direct association between Vitamin D levels and the clinical course of HL needs to be collected to advance the understanding of the role of Vitamin D in HL.
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Affiliation(s)
- Sven Borchmann
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany.
| | - Horst Müller
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Andreas Engert
- German Hodgkin Study Group (GHSG), Department I of Internal Medicine, University Hospital Cologne, Cologne, Germany
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Affiliation(s)
- Geraldine Kyle
- Nurse Tutor, Centre for Learning and Development at Tallaght Hospital, Dublin 24, Ireland
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Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma. Blood Cancer J 2017; 7:e595. [PMID: 28841207 PMCID: PMC5596381 DOI: 10.1038/bcj.2017.70] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 12/04/2022] Open
Abstract
We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002–2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18–3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37–4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52–5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26–7.13), OS (HR=2.86; 95% CI 1.39–5.85), and LSS (HR=2.96; 95% CI 1.29–6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20–6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01–9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.
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Radujkovic A, Kordelas L, Krzykalla J, Beelen DW, Benner A, Lehners N, Schmidt K, Dreger P, Luft T. Pretransplant Vitamin D Deficiency Is Associated With Higher Relapse Rates in Patients Allografted for Myeloid Malignancies. J Clin Oncol 2017; 35:3143-3152. [PMID: 28771378 DOI: 10.1200/jco.2017.73.0085] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Vitamin D (VitD) deficiency is common in patients with hematologic malignancies undergoing allogeneic transplantation (alloSCT), but its prognostic relevance is unclear. Patients and Methods The impact of pretransplant VitD status on overall survival, relapse mortality, and nonrelapse mortality was investigated retrospectively in a cohort of 492 patients undergoing alloSCT at our center from 2002 to 2013. VitD deficiency was defined as a serum level of 25-hydroxyvitamin D3 < 20 ng/mL (equivalent to < 50 nM) before alloSCT and was assessed using accredited laboratory methods and a standard chemiluminescent immunoassay. Results were validated in an independent cohort of 398 patients diagnosed with myeloid malignancies. Results A total of 396 (80%) and 348 (87%) patients had VitD deficiency before alloSCT in the training and validation cohort, respectively. In the training cohort, VitD deficiency was significantly associated with inferior overall survival (hazard ratio [HR], 1.78; P = .007) in multivariable analysis. This was due to a higher risk of relapse (HR, 1.96; P = .006) rather than nonrelapse mortality. A significant association of pretransplant VitD deficiency with higher relapse rates was observed only in patients diagnosed with myeloid (HR, 2.55; P = .014) but not with lymphatic diseases (HR, 1.60; P = .147). A similar impact of pretransplant VitD deficiency on relapse risk in myeloid diseases was also observed in an independent patient cohort (HR, 2.60; P = .017). Validation of the effect of VitD deficiency on relapse in patients with myeloid malignancies was successful. Conclusion Pretransplant VitD deficiency was associated with a higher risk of relapse in patients allografted for myeloid malignancies. Prospective studies on VitD status and correction of VitD deficiency in the setting of alloSCT are highly warranted.
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Affiliation(s)
- Aleksandar Radujkovic
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Lambros Kordelas
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Julia Krzykalla
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Dietrich W Beelen
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Axel Benner
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Nicola Lehners
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Katharina Schmidt
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Peter Dreger
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
| | - Thomas Luft
- Aleksandar Radujkovic, Nicola Lehners, Katharina Schmidt, Peter Dreger, and Thomas Luft, University Hospital Heidelberg; Julia Krzykalla and Axel Benner, German Cancer Research Center, Heidelberg; and Lambros Kordelas and Dietrich W. Beelen, University Hospital, Essen, Germany
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High Prevalence of Vitamin D Deficiency in Newly Diagnosed Acute Myeloid Leukemia Patients and Its Adverse Outcome. Int J Hematol Oncol Stem Cell Res 2017; 11:209-216. [PMID: 28989587 PMCID: PMC5625471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Although several studies have supported a preventive and therapeutic role of vitamin D (Vit D) for different types of cancers, we face insufficient documentation in acute myeloid leukemia (AML). So, we examined whether the serum calcidiol (25(OH)D) levels at the time of induction therapy have any impact on response and relapse in AML patients. Materials and Methods: Blood samples were collected from 65 patients on days 0 and 28th of treatment to evaluate serum concentration of 25(OH)D and its effects on complete remission (CR) achievement, relapse rate and hospitalization length. Results: Of the 65 patients who were included in the study, 38 were male (58.5%) and 27 were female (41.5%). Median age at the time of treatment was 37 years (range 15-68). 6% of the participants were older than 60 years. In regard to 25(OH)D levels, 81.5% of AML patients were deficient (levels <20 ng/ml). There was a significant difference in CR between patients with sufficient and deficient level of 25(OH)D. Deficient patients had longer length of hospitalization than those with sufficient levels. Also Vitamin D deficient patients had higher serum ALP levels. The mean level of 25(OH)D on treatment day 28th in our study was significantly lower than the baseline value. Conclusion: The results of the study showed that serum 25(OH)D levels deficiency was highly prevalent among Iranian AML patients. Furthermore, higher Vit D levels in AML patients were associated with better outcome in these patients.
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Ammann EM, Drake MT, Haraldsson B, Wallace RB, Johnson KC, Desai P, Lin EM, Link BK. Incidence of hematologic malignancy and cause-specific mortality in the Women's Health Initiative randomized controlled trial of calcium and vitamin D supplementation. Cancer 2017; 123:4168-4177. [PMID: 28654155 DOI: 10.1002/cncr.30858] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/11/2017] [Accepted: 05/29/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prior evidence of a possible link between vitamin D status and hematologic malignancy (HM) in humans comes from observational studies, leaving unresolved the question of whether a true causal relationship exists. METHODS The authors performed a secondary analysis of data from the Women's Health Initiative Calcium/Vitamin D (CaD) trial, a large randomized controlled trial of CaD supplementation compared with placebo in older women. Kaplan-Meier and Cox proportional hazards survival analysis methods were used to evaluate the relationship between treatment assignment and 1) incident HM and 2) HM-specific mortality over 10 years following randomization. HMs were classified by cell type (lymphoid, myeloid, or plasma cell) and analyzed as distinct endpoints in secondary analyses. RESULTS A total of 34,763 Women's Health Initiative CaD trial participants (median age, 63 years) had complete baseline covariate data and were eligible for analysis. Women assigned to CaD supplementation had a significantly lower risk of incident HM (hazard ratio [HR], 0.80; 95% confidence interval [95% CI], 0.65-0.99) but not HM-specific mortality (HR, 0.77 [95% CI, 0.53-1.11] for the entire cohort; and HR, 1.03 [95% CI, 0.70-1.51] among incident HM cases after diagnosis). In secondary analyses, protective associations were found to be most robust for lymphoid malignancies, with HRs of 0.77 (95% CI, 0.59-1.01) and 0.46 (95% CI, 0.24-0.89), respectively, for cancer incidence and mortality in those assigned to CaD supplementation. CONCLUSIONS The current post hoc analysis of data from a large and well-executed randomized controlled trial demonstrates a protective association between modest CaD supplementation and HM risk in older women. Additional research concerning the relationship between vitamin D and HM is warranted. Cancer 2017;123:4168-4177. © 2017 American Cancer Society.
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Affiliation(s)
- Eric M Ammann
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Matthew T Drake
- Department of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Bjarni Haraldsson
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
| | - Robert B Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Pinkal Desai
- Division of Hematology and Medical Oncology, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Emily M Lin
- Department of Internal Medicine, Harbor UCLA Medical Center, Torrance, California
| | - Brian K Link
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Strati P, Parikh SA, Chaffee KG, Kay NE, Call TG, Achenbach SJ, Cerhan JR, Slager SL, Shanafelt TD. Relationship between co-morbidities at diagnosis, survival and ultimate cause of death in patients with chronic lymphocytic leukaemia (CLL): a prospective cohort study. Br J Haematol 2017; 178:394-402. [PMID: 28580636 DOI: 10.1111/bjh.14785] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
Abstract
The ultimate cause of death for most patients with newly diagnosed chronic lymphocytic leukaemia (CLL) and its relationship to co-morbid health conditions is poorly defined. We conducted a prospective cohort study that systematically followed 1143 patients diagnosed with CLL between June 2002 and November 2014. Comorbid health conditions at the time of CLL diagnosis and their relationship to survival and cause of death were evaluated. Collectively, 1061 (93%) patients had at least one co-morbid health condition at the time of CLL diagnosis (median number 3). Despite this, 89% of patients had a low-intermediate Charlson Comorbidity Index score (CCI) at diagnosis. After a median follow-up of 6 years, 225 patients have died. Death was due to CLL progression in 85 (46%) patients, infection in 14 (8%) patients, other cancer in 35 (19%) patients and comorbid health conditions in 50 (27%) patients. Higher CCI score and a greater number of major comorbid health conditions at the time of CLL diagnosis was associated with shorter non-CLL specific survival, but not with shorter CLL-specific survival on multivariate analysis. In conclusion, CLL and CLL-related complications (infections and second cancers) are the overwhelming cause of death in patients with CLL, regardless of CCI score and number of comorbid health conditions at diagnosis.
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Affiliation(s)
- Paolo Strati
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | - Neil E Kay
- Mayo Clinic College of Medicine, Rochester, MN, USA
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Vaughan-Shaw PG, O'Sullivan F, Farrington SM, Theodoratou E, Campbell H, Dunlop MG, Zgaga L. The impact of vitamin D pathway genetic variation and circulating 25-hydroxyvitamin D on cancer outcome: systematic review and meta-analysis. Br J Cancer 2017; 116:1092-1110. [PMID: 28301870 PMCID: PMC5396104 DOI: 10.1038/bjc.2017.44] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/20/2017] [Accepted: 01/26/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Vitamin D has been linked with improved cancer outcome. This systematic review and meta-analysis investigates the relationship between cancer outcomes and both vitamin D-related genetic variation and circulating 25-hydroxyvitamin D (25OHD) concentration. METHODS A systematic review and meta-analysis of papers until November 2016 on PubMed, EMBASE and Web of Science pertaining to association between circulating vitamin D level, functionally relevant vitamin D receptor genetic variants and variants within vitamin D pathway genes and cancer survival or disease progression was performed. RESULTS A total of 44 165 cases from 64 studies were included in meta-analyses. Higher 25OHD was associated with better overall survival (hazard ratio (HR=0.74, 95% CI: 0.66-0.82) and progression-free survival (HR=0.84, 95% CI: 0.77-0.91). The rs1544410 (BsmI) variant was associated with overall survival (HR=1.40, 95% CI: 1.05-1.75) and rs7975232 (ApaI) with progression-free survival (HR=1.29, 95% CI: 1.02-1.56). The rs2228570 (FokI) variant was associated with overall survival in lung cancer patients (HR=1.29, 95% CI: 1.0-1.57), with a suggestive association across all cancers (HR=1.26, 95% CI: 0.96-1.56). CONCLUSIONS Higher 25OHD concentration is associated with better cancer outcome, and the observed association of functional variants in vitamin D pathway genes with outcome supports a causal link. This analysis provides powerful background rationale to instigate clinical trials to investigate the potential beneficial effect of vitamin D in the context of stratification by genotype.
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Affiliation(s)
- P G Vaughan-Shaw
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH42XU, UK
| | - F O'Sullivan
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 24, Republic of Ireland
| | - S M Farrington
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH42XU, UK
| | - E Theodoratou
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH42XU, UK
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH164UX, UK
| | - H Campbell
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH42XU, UK
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH164UX, UK
| | - M G Dunlop
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh EH42XU, UK
| | - L Zgaga
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 24, Republic of Ireland
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Sfeir JG, Drake MT, LaPlant BR, Maurer MJ, Link BK, Berndt TJ, Shanafelt TD, Cerhan JR, Habermann TM, Feldman AL, Witzig T. Validation of a vitamin D replacement strategy in vitamin D-insufficient patients with lymphoma or chronic lymphocytic leukemia. Blood Cancer J 2017; 7:e526. [PMID: 28157213 PMCID: PMC5386343 DOI: 10.1038/bcj.2017.9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- J G Sfeir
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Internal Medicine Mayo Clinic, Rochester, MN, USA
| | - M T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition Department of Internal Medicine Mayo Clinic, Rochester, MN, USA
| | - B R LaPlant
- Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, MN, USA
| | - M J Maurer
- Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, MN, USA
| | - B K Link
- Holden Comprehensive Cancer Center University of Iowa, Iowa City, IA, USA
| | - T J Berndt
- Mayo Clinic Health Science Research, Rochester, MN, USA
| | - T D Shanafelt
- Mayo Clinic Cancer Center Mayo Clinic, Rochester, MN, USA
| | - J R Cerhan
- Mayo Clinic Health Science Research, Rochester, MN, USA
| | - T M Habermann
- Mayo Clinic Cancer Center Mayo Clinic, Rochester, MN, USA
| | - A L Feldman
- Department of Laboratory Medicine and Pathology Mayo Clinic, Rochester, MN, USA
| | - T Witzig
- Mayo Clinic Cancer Center Mayo Clinic, Rochester, MN, USA
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46
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Bruns H, Böttcher M, Qorraj M, Fabri M, Jitschin S, Dindorf J, Busch L, Jitschin R, Mackensen A, Mougiakakos D. CLL-cell-mediated MDSC induction by exosomal miR-155 transfer is disrupted by vitamin D. Leukemia 2016; 31:985-988. [PMID: 28008175 DOI: 10.1038/leu.2016.378] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- H Bruns
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Böttcher
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Qorraj
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Fabri
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - S Jitschin
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - J Dindorf
- Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - L Busch
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - R Jitschin
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Mackensen
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - D Mougiakakos
- Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany
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47
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Kulling PM, Olson KC, Olson TL, Feith DJ, Loughran TP. Vitamin D in hematological disorders and malignancies. Eur J Haematol 2016; 98:187-197. [PMID: 27743385 DOI: 10.1111/ejh.12818] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 12/13/2022]
Abstract
Commonly known for its critical role in calcium homeostasis and bone mineralization, more recently vitamin D has been implicated in hematological cancer pathogenesis and shows promise as an anti-cancer therapy. Serum levels of 25(OH)D3 , the precursor to the active form of vitamin D, calcitriol, are frequently lower in patients with hematological disease compared to healthy individuals. This often correlates with worse disease outcome. Furthermore, diseased cells typically highly express the vitamin D receptor, which is required for many of the anti-cancer effects observed in multiple in vivo and in vitro cancer models. In abnormal hematological cells, vitamin D supplementation promotes apoptosis, induces differentiation, inhibits proliferation, sensitizes tumor cells to other anti-cancer therapies, and reduces the production of pro-inflammatory cytokines. Although the dosage of vitamin D required to achieve these effects may induce hypercalcemia in humans, analogs and combinatorial treatments have been developed to circumvent this side effect. Vitamin D and its analogs are well tolerated in clinical trials, and thus, further investigation into the use of these agents in the clinic is warranted. Here, we review the current literature in this field.
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Affiliation(s)
- Paige M Kulling
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA.,Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | - Kristine C Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Thomas L Olson
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - David J Feith
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Thomas P Loughran
- University of Virginia Cancer Center, University of Virginia, Charlottesville, VA, USA.,Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA
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48
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Mauro FR, Salaroli A, Caputo MD, Colafigli G, Petrucci L, Campanelli M, Ferretti A, Guarini AR, Foà R. Management of elderly and unfit patients with chronic lymphocytic leukemia. Expert Rev Hematol 2016; 9:1165-1175. [DOI: 10.1080/17474086.2016.1254544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Olszewski AJ, Gutman R, Eaton CB. Increased risk of axial fractures in patients with untreated chronic lymphocytic leukemia: a population-based analysis. Haematologica 2016; 101:e488-e491. [PMID: 27662013 DOI: 10.3324/haematol.2016.148858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Adam J Olszewski
- Division of Hematology-Oncology, Alpert Medical School of Brown University, Providence, RI, USA .,Division of Hematologic Malignancies, Rhode Island Hospital, Providence, RI, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University, Providence, RI, USA
| | - Charles B Eaton
- Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA.,Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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50
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Parry HM, Damery S, Hudson C, Maurer MJ, Cerhan JR, Pachnio A, Begum J, Slager SL, Fegan C, Man S, Pepper C, Shanafelt TD, Pratt G, Moss PAH. Cytomegalovirus infection does not impact on survival or time to first treatment in patients with chronic lymphocytic leukemia. Am J Hematol 2016; 91:776-81. [PMID: 27124884 PMCID: PMC4957613 DOI: 10.1002/ajh.24403] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 01/10/2023]
Abstract
Human cytomegalovirus (HCMV) is a widely prevalent herpes virus which establishes a state of chronic infection. The establishment of CMV‐specific immunity controls viral reactivation and leads to the accumulation of very large numbers of virus‐specific T cells which come to dominate the immune repertoire. There is concern that this may reduce the immune response to heterologous infections and HCMV infection has been associated with reduced survival in elderly people. Patients with chronic lymphocytic leukemia (B‐CLL) suffer from a state of immune suppression but have a paradoxical increase in the magnitude of the CMV‐specific T cell and humoral immune response. As such, there is now considerable interest in how CMV infection impacts on the clinical outcome of patients with B‐CLL. Utilizing a large prospective cohort of patients with B‐CLL (n = 347) we evaluated the relationship between HCMV seropositivity and patient outcome. HCMV seropositive patients had significantly worse overall survival than HCMV negative patients in univariate analysis (HR = 2.28, 95% CI: 1.34–3.88; P = 0.002). However, CMV seropositive patients were 4 years older than seronegative donors and this survival difference was lost in multivariate modeling adjusted for age and other validated prognostic markers (P = 0.34). No significant difference was found in multivariate modeling between HCMV positive and negative patients in relation to the time to first treatment (HR = 1.12, 95% CI: 0.68–1.84; P = 0.65). These findings in a second independent cohort of 236 B‐CLL patients were validated. In conclusion no evidence that HCMV impacts on the clinical outcome of patients with B‐CLL was found. Am. J. Hematol. 91:776–781, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Helen Marie Parry
- Institute of Immunology and Immunotherapy; University of Birmingham; Birmingham B15 2TT United Kingdom
| | - Sarah Damery
- Institute of Applied Health Research; University of Birmingham; Birmingham B15 2TT United Kingdom
| | - Christopher Hudson
- Faculty of Medicine & Health Sciences; University of Nottingham; Leicestershire LE12 5RD United Kingdom
| | - Matthew J. Maurer
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - James R. Cerhan
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Annette Pachnio
- Institute of Immunology and Immunotherapy; University of Birmingham; Birmingham B15 2TT United Kingdom
| | - Jusnara Begum
- Institute of Immunology and Immunotherapy; University of Birmingham; Birmingham B15 2TT United Kingdom
| | - Susan L. Slager
- Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Christopher Fegan
- Division of Cancer & Genetics; Heath Park; Cardiff CF14 4XN United Kingdom
| | - Stephen Man
- Division of Cancer & Genetics; Heath Park; Cardiff CF14 4XN United Kingdom
| | - Christopher Pepper
- Division of Cancer & Genetics; Heath Park; Cardiff CF14 4XN United Kingdom
| | | | - Guy Pratt
- Institute of Immunology and Immunotherapy; University of Birmingham; Birmingham B15 2TT United Kingdom
| | - Paul A. H. Moss
- Institute of Immunology and Immunotherapy; University of Birmingham; Birmingham B15 2TT United Kingdom
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