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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.
Shreve, Nancy; Goyal, Rakesh; Staggs, Vincent S.; Walters, Katrina; Domen, Jos; Freundenthal, Jean; Garg, Uttam; Green, Nancy; Rahmetulla, Rukhsana; Terwilliger, Nancy; Radhi, Mohamed; and Dalal, Jignesh, "Improved Vitamin D Status Over Time in Children Undergoing Hematopoietic Cell Transplantation" (2019). Research at Children's Mercy Month 2019. 6.