Download Full Text (710 KB)

Publication Date



BACKGROUND: Vitamin D deficiency is prevalent in children undergoing hematopoietic cell transplantation (HCT), and has been correlated with risk of post-transplant complications and inferior survival. We report findings from a prospective non-interventional study of vitamin D status over time in pediatric HCT patients.

METHODS: Patients between >1 mo. and ≤21 y age were eligible. Blood samples were drawn to measure 25-hydroxy vitamin D (“vitamin D”) levels at pre-HCT, and 100 days, 6 mo., 1 y, and 2 y post-HCT timepoints. Vitamin D levels were classified as sufficient ( ≥ 30 ng/ml), insufficient (20–29 ng/ml) or deficient ( < 20 ng/ml). All patients were followed by registered dieticians. Logistic mixed models were used to examine vitamin D status across time.

RESULTS: Sixty-six patients were enrolled, median age 8.1 y (0.4 y -20.5 y). 73% of patients received myeloablative conditioning. The median vitamin D level prior to HCT was 27 ng/ml (range: 8 ng/ml – 69 ng/ml). Levels were insufficient and deficient in 33% and 23% patients (Table 1). Only 24% of children > 12 y had sufficient vitamin D levels compared with 44% and 64% in in ages 4-12 and below 4 y respectively. Only 24% female patients had normal vitamin D levels compared with 45% male patients. Vitamin D sufficiency rates were similar between whites and non-whites. Compared to pre-HCT, estimated odds of “below sufficient” (either insufficient or deficient) were 47% higher at 100 days, 30% higher at 6 mo., 69% lower at 1 y, and 81% lower at 2 y (linear trend p = .023) and estimated odds of sufficiency were 39% lower at 100 days, 21% lower at 6 mo., and 41-42% higher at 1 y and 2 y (linear trend p = .087)(Figure 1). A review of medical records showed that proportion of patients receiving supplemental vitamin D were 7.5%, 10%, 19%, 30% and 42% at pre-HCT, +100 days, 6 mo., 1 and 2 y post-HCT time-points, respectively.

CONCLUSIONS: We show a high prevalence rate of vitamin D insufficiency and deficiency prior to and early after HCT. We also found that the odds of vitamin D sufficiency improved over 1 – 2 y post-HCT. We recommend that all pediatric patients should be screened for vitamin D status prior to and at day 100 post-transplant and those with low levels ( <2 0 ng/mL) treated. Clinical significance of this approach needs to be examined in a large multicenter trial.

Document Type


Improved Vitamin D Status Over Time in Children Undergoing Hematopoietic Cell Transplantation



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.