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


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


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


CONCLUSIONS
25(OH)D insufficiency was associated with inferior EFS and OS in DLBCL and T-cell lymphoma. Whether normalizing vitamin D levels in these patients improves outcomes will require testing in future trials.
Drake
Matthew T
MT
College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Maurer
Matthew J
MJ
Link
Brian K
BK
Habermann
Thomas M
TM
Ansell
Stephen M
SM
Micallef
Ivana N
IN
Kelly
Jennifer L
JL
Macon
William R
WR
Nowakowski
Grzegorz S
GS
Inwards
David J
DJ
Johnston
Patrick B
PB
Singh
Ravinder J
RJ
Allmer
Cristine
C
Slager
Susan L
SL
Weiner
George J
GJ
Witzig
Thomas E
TE
Cerhan
James R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D002853:Chromatography, Liquid; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007484:Iowa; D053208:Kaplan-Meier Estimate; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D053719:Tandem Mass Spectrometry; D013997:Time Factors; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications / Q000401:mortality*; D055815:Young Adult
D015415:Biomarkers; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; C104450:25-hydroxyvitamin D