title: Vitamin D level after allogeneic hematopoietic stem cell transplant.
abstract: Vitamin D (VD) deficiency can cause osteomalacia, bone pain, muscle weakness, fatigue, and increased risk of fracture, and may precipitate or exacerbate osteopenia and osteoporosis. Patients receiving treatment for acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) may have limited exposure to sunlight and often experience gastrointestinal side effects that may decrease their ability to maintain an adequate VD level. We hypothesized that patients with AML and ALL would have a low VD level after allogeneic hematopoietic cell transplant (HCT), and that these patients would have a high incidence of osteoporosis/osteopenia. We therefore studied the incidence of low VD level and low bone mineral density after HCT. Of 289 patients with AML or ALL undergoing HCT between January 1, 2000, and January 31, 2009, at the Cleveland Clinic, 58 (20.1%) patients had VD testing after HCT. Of these, 52 (89.7%) patients had a low VD level, and 6 (10.3%) had a normal level. Most patients with VD testing had graft-versus-host disease (GVHD) and were taking corticosteroids (94.8% and 98.3%, respectively). Of the 49 patients with VD testing who also had bone mineral density testing, 65% had abnormal (low bone density) results. Only 21% of patients with VD testing were taking VD supplements prior to testing, and 65% had an elevated parathyroid hormone level. We found that most patients did not have VD testing after HCT, but those that did were very likely to have a low level and have low bone mineral density. Those with a low VD level were likely to have received corticosteroids, have GVHD, and have an elevated parathyroid hormone (PTH) level. Given the potential morbidity of low VD level, VD deficiency should be considered after HCT. Prospective study of VD level and its impact on morbidity and mortality after HCT is warranted.
authors.affiliation: Banner Blood and Marrow Transplant Program, Phoenix, AZ 85006, USA. lisa.sproat@bannerhealth.com
authors.forename: Lisa
authors.initials: L
authors.lastname: Sproat
authors.forename: Brian
authors.initials: B
authors.lastname: Bolwell
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.forename: Robert
authors.initials: R
authors.lastname: Dean
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.forename: Brad
authors.initials: B
authors.lastname: Pohlman
authors.forename: Steven
authors.initials: S
authors.lastname: Andresen
authors.forename: John
authors.initials: J
authors.lastname: Sweetenham
authors.forename: Edward
authors.initials: E
authors.lastname: Copelan
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology; D019587:Dietary Supplements; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000097:blood* / Q000601:surgery; D008297:Male; D044342:Malnutrition / Q000150:complications; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000601:surgery; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood*; D014808:Vitamin D Deficiency / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D010281:Parathyroid Hormone; D014807:Vitamin D