title: Significant 25-hydroxyvitamin D deficiency in child and adolescent survivors of acute lymphoblastic leukemia: treatment with chemotherapy compared with allogeneic stem cell transplant.
abstract: BACKGROUND
  25-hydroxyvitamin D insufficiency is common in healthy children and adolescents. There have been limited studies of the 25-hydroxyvitamin D status of survivors of pediatric and adolescent acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  In a cohort of 78 ALL survivors (52 chemotherapy-treated and 26 HCT-treated), we determined the prevalence of, and host, treatment and environmental risk factors for 25-hydroxyvitamin D insufficiency and deficiency.
  
  
  RESULTS
  There were no differences in serum 25-hydroxyvitamin D levels between ALL survivors treated with conventional chemotherapy and those treated with HCT (median 26.0 vs 25.5 ng/ml). Fifty-three percent of pediatric ALL survivors were 25-hydroxyvitamin D insufficient (15-29 ng/dl), and 12% were deficient (<15 ng/dl). Younger age, higher reported dietary vitamin D intake, use of vitamin D supplementation, and increased ambient ultraviolet light were associated with higher serum 25-hydroxyvitamin D levels. There was not enough evidence to suggest treatment type, gender, race, years since diagnosis or BMI were associated with serum 25-hydroxyvitamin D levels. Only 27% of conventional chemotherapy-treated ALL survivors and 8% of HCT-treated ALL survivors met RDA for dietary vitamin D intake.
  
  
  CONCLUSIONS
  The prevalence of vitamin D deficiency and insufficiency in ALL survivors is similar to that of the general pediatric population in the United States, and there is no difference in serum 25-hydroxyvitamin D status between chemotherapy-treated and HCT-treated ALL survivors. ALL survivors rarely meet the RDA requirements for vitamin D. Further studies are needed to determine whether dietary and behavioral interventions can improve the vitamin D status of ALL survivors.
authors.affiliation: Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt Children's Hospital, Nashville, Tennessee, USA. jill.h.simmons@vanderbilt.edu
authors.forename: Jill H
authors.initials: JH
authors.lastname: Simmons
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chow
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Koehler
authors.forename: Adam
authors.initials: A
authors.lastname: Esbenshade
authors.forename: Lesley-Ann
authors.initials: LA
authors.lastname: Smith
authors.forename: Jean
authors.initials: J
authors.lastname: Sanders
authors.forename: Debra
authors.initials: D
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002648:Child; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy*; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D015996:Survival Rate; D017741:Survivors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000209:etiology*; D055815:Young Adult
chemical_list: D014807:Vitamin D; D003520:Cyclophosphamide; C104450:25-hydroxyvitamin D; D011241:Prednisone