Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia (CLL)

[Guest guest]

BlankI wouldn't be surprised if further research found that at least in some

instances, vitamin D insufficency is the result rather than the cause of CLL

progression.

This comment is based on personal experience. For years, I was taking 2000 IU

of Vit. D supplement daily. During this time I had two tests for D and both

showed normal levels.

As my CLL progressed and my WBC gradually increased from 15,000 to 285,000,

another test showed very low vitamin D levels, even though I had maintained the

2,000 IU daily supplementation all along. My conclusion is that it was CLL

progression that interfered with the absorption of vitamin D..

Andy

Blood First Edition Paper, prepublished online November 3, 2010; DOI

10.1182/blood-2010-07-295683.

Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia (CLL)

Tait D. Shanafelt1,*, T. Drake2, J. Maurer3, Cristine Allmer3,

Kari G. Rabe3, L. Slager3, J. Weiner4, G. Call1, K.

Link4, Clive S. Zent1, Neil E. Kay1, Curtis A. Hanson5, E. Witzig1 and

R. Cerhan6

1 Division of Hematology, Department of Internal Medicine, Mayo Clinic,

Rochester, MN, United States; 2 Division of Endocrinology, Department of

Internal Medicine, Mayo Clinic, Rochester, MN, United States; 3 Division of

Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, United States;

4 Division of Hematology, Oncology, and Blood & Marrow Transplantation, Dept. of

Internal Medicine, College of Medicine, University of Iowa, Iowa City, IA,

United States; 5 Department of Pathology, Mayo Clinic, Rochester, MN, United

States; 6 Division of Epidemiology, Mayo Clinic, Rochester, MN, United States

* Corresponding author; email: shanafelt.tait@...

Abstract

Vitamin D insufficiency is common globally with low levels linked to higher

cancer incidence. Although vitamin D insufficiency is related to inferior

prognosis in some cancers, no data exist for chronic lymphocytic leukemia/small

lymphocytic lymphoma (CLL). We evaluated the relationship of 25(OH)D serum

levels with time-to-treatment(TTT) and overall survival(OS) in newly diagnosed

CLL patients participating in a prospective cohort study (discovery cohort) and

a separate cohort of previously untreated patients participating in an

observational study(confirmation cohort). Of 390 CLL patients in the discovery

cohort, 119(30.5%) were 25(OH)D insufficient. After median follow-up of 3 years,

TTT(hazard ratio

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=1.66; p=0.005) and OS(HR=2.39; p=0.01) were shorter for

25(OH)D insufficient patients. In the validation cohort, 61 of 153

patients(39.9%) were 25(OH)D insufficient. After median follow-up of 9.9 years,

TTT(HR=1.59; p=0.05) and OS(HR 1.63; p=0.06) were again shorter for 25(OH)D

insufficient patients. On pooled multivariable analysis of patients in both

cohorts adjusting for age, sex, stage, CD38, ZAP-70, IGHV, CD49d, and FISH,

25(OH)D insufficiency remained an independent predictor of TTT(HR=1.47;

p=0.008), although the association with OS was not significant(HR=1.47; p=0.07).

Vitamin D insufficiency is associated with inferior TTT and OS in CLL patients.

Whether normalizing vitamin D levels in deficient CLL patients would improve

outcome merits clinical testing.