#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Levels and signifi cance of vitamin D in patients with malignant lymphomas


Authors: A. Janíková 1,2;  M. Hájek 2;  P. Blahovcová 3;  M. Tomíška 1,2;  D. Valík 4;  N. Kopálová 5
Published in: Transfuze Hematol. dnes,31, 2025, No. 1, p. 19-26.
Category: Original Papers
doi: https://doi.org/10.48095/cctahd2025prolekare.cz3

Overview

Objectives: Vitamin D deficiency is associated with worse prognosis in several diseases. In our study, we analysed vitamin D levels in patients with non-Hodgkin lymphomas (NHL) in the Czech Republic. Methods: A retrospective analysis of newly diagnosed patients who had their plasma levels of vitamin D, selected micronutrients (selenium, zinc), albumin, and IgG measured before initiating treatment. The analysis included the association of vitamin D with demographic, clinical, and selected laboratory parameters, as well as the impact of vitamin D deficiency on survival. Results: A total of 1,196 patients were analysed (median age 65 years, 49.5% male). The median vitamin D concentration was 43.5 nmol/L. Vitamin D deficiency (≤ 50 nmol/L) was observed in 717/1,196 patients (59.9%), while only 14.1% had normal levels (≥ 75 nmol/L). The median follow-up period was 3.9 years. Female gender (P < 0.000001), poor performance status (PS ≥ 2; P < 0.0001), elevated LDH levels (P = 0.0063), and hypoalbuminemia (P < 0.000001) were associated with vitamin D deficiency. Significantly lower vitamin D levels were observed in aggressive lymphomas (P = 0.000002). In diffuse large B-cell lymphoma, vitamin D deficiency correlated with shorter progression-free survival and overall survival (5.16 years vs. not reached and 8.9 years vs. not reached; P < 0.01). For follicular lymphoma, there was no difference in progression-free survival; however, 5-year overall survival was 80% vs. 95% (P = 0.0007). Conclusion: Vitamin D deficiency prior to treatment is a concern for the majority of patients with NHL. It is associated with other negative prognostic factors (hypoalbuminemia, elevated LDH, poorer clinical status) and with shorter survival.

Keywords:

Prognosis – Lymphomas – immune system – survival – vitamin D


Sources

1. Srivastava SB. Vitamin D: do we need more than sunshine? Am J Lifestyle Med. 2021; 15 (4): 397–401. doi: 10.1177/155982762110 05689.

2. Holick MF. Biological effects of sunlight, ultraviolet radiation, visible light, infrared radiation and vitamin D for health. Anticancer Res. 2016; 36 (3): 1345–1356.

3. Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016; 103: 1033–1044.

4. Yeum KJ, Song BC, Joo NS. Impact of geographic location on vitamin D status and bone mineral density. Int J Environ Res Public Health. 2016; 13 (2): 184. doi: 10.3390/ijerph13020184.

5. Bennour I, Haroun N, Sicard F, Mounien L, Landrier JF. Vitamin D and obesity/adiposity – a brief overview of recent studies. Nutrients. 2022; 14 (10): 2049. doi: 10.3390/nu14102049.

6. Grant WB, Garland CF. A critical review of studies on vitamin D in relation to colorectal cancer. Nutr Cancer. 2004; 48 (2): 115–123.

7. Łuczyńska A, Kaaks R, Rohrmann S, et al. Plasma 25-hydroxyvitamin D concentration and lymphoma risk: results of the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2013; 98 (3): 827–838.

8. Kelly JL, Friedberg JW, Calvi LM, van Wijngaarden E, Fisher SG. Vitamin D and non-Hodgkin lymphoma risk in adults: a review. Cancer Invest. 2009; 27 (9): 942–951. doi: 10.3109/07357900902849632.

9. Hickish T, Cunningham D, Colston K, et al. The effect of 1,25-dihydroxyvitamin D3 on lymphoma cell lines and expression of vitamin D receptor in lymphoma. Br J Cancer. 1993; 68: 668–672.

10. Consolini R, Pala S, Legitimo A, et al. Effects of vitamin D on the growth of normal and malignant B-cell progenitors. Clin Exp Immunol. 2001; 126: 214–219.

11. Sýkorová A, Belada D, Smolej L, et al. Určování rozsahu onemocnění u non-Hodgkinových lymfomů – doporučení Kooperativní lymfomové skupiny. Klin Onkol. 2010; 23 (3): 146–154.

12. Kelly JL, Salles G, Goldman B, et al. Low serum vitamin D levels are associated with inferior survival in follicular lymphoma: a prospective evaluation in SWOG and LYSA studies. J Clin Oncol. 2015; 33: 1482–1490.

13. Verdoia M, Schaffer A, Barbieri L, et al. Novara Atherosclerosis Study Group (NAS). Impact of gender difference on vitamin D status and its relationship with the extent of coronary artery disease. Nutr Metab Cardiovasc Dis. 2015; 25 (5): 464–470.

14. Rybchyn MS, Abboud M, Puglisi DA, et al. Skeletal muscle and the maintenance of vitamin D status. Nutrients. 2020; 12 (11): 3270. doi: 10.3390/nu12113270.

15. Drake MT, Maurer MJ, Link BK, et al. Vitamin D insufficiency and prognosis in non-Hodgkin‘s lymphoma. J Clin Oncol. 2010; 28: 4191–4198.

16. Tracy SI, Maurer MJ, Witzig TE, et al. Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma. Blood Cancer J. 2017; 7 (8): e595. doi: 10.1038/bcj.2017.70.

17. Orces C. The Association between body mass index and vitamin D supplement use among adults in the United States. Cureus. 2019; 11 (9): e5721. doi: 10.7759/cureus.5721.

18. Maha O, Nawal O, Youssef A, et al. Hypovitaminosis D in haematological malignancies: cause or consequence? Nutr Cancer. 2023; 75 (10): 1911–1917.

19. Han YM, Yoon H, Lim S, et al. Risk factors for vitamin D, zinc, and selenium deficiencies in Korean patients with inflammatory bowel disease. Gut Liver. 2017; 11 (3): 363–369.

20. Hohaus S, Tisi MC, Bellesi S, et al. Vitamin D deficiency and supplementation in patients with aggressive B-cell lymphomas treated with immunochemotherapy. Cancer Med. 2018; 7 (1): 270–281. doi: 10.1002/cam4. 1166.

21. Bittenbring JT, Neumann F, Altmann B, et al. Vitamin D deficiency impairs rituximab-mediated cellular cytotoxicity and outcome of patients with diffuse large B-cell lymphoma treated with but not without rituximab. J Clin Oncol. 2014; 32 (29): 3242–3248. doi: 10.1200/JCO.2013.53.4537.

22. Nakamura N, Kanemura N, Matsumoto T, et al. Effect of vitamin D and skeletal muscle mass on prognosis of patients with diffuse large B-cell lymphoma. Nutrients. 2024; 16 (16): 2653. doi: 10.3390/nu16162653.

23. Nath K, Tomas AA, Flynn J, et al. Vitamin D insufficiency and clinical outcomes with chimeric antigen receptor T-cell therapy in large B-cell lymphoma. Transplant Cell Ther. 2022; 28 (11): 751.e1–751.e7. doi: 10.1016/j.jtct.2022.08.001.

24. Tadmor T, Melamed G, Alapi H, et al. Vitamin D supplement for patients with early-stage chronic lymphocytic leukemia is associated with a longer time to first treatment. Blood Adv. 2024; 8 (14): 3840–3846.

25. Hohaus S, Tisi MC, Bellesi S, et al. Vitamin D deficiency and supplementation in patients with aggressive B-cell lymphomas treated with immunochemotherapy. Cancer Med. 2018; 7 (1): 270–281. doi: 10.1002/cam4.1166.

26. Friedberg JW, Brady MT, Strawderman M, et al. Ilyad: a phase III double blind, randomized trial evaluating vitamin D (cholecalciferol) in patients with low tumor-burden indolent non-Hodgkin lymphoma treated with rituximab therapy. Blood. 2023; 142 (Suppl 1): 606. https: //doi.org/10.1182/blood-2023-178088.

27. Caballero-Velázquez T, Montero I, Sánchez-Guijo F, et al. Immunomodulatory effect of vitamin D after allogeneic stem cell transplantation: results of a prospective multicenter clinical trial. Clin Cancer Res. 2016; 22 (23): 5673–5681.

Labels
Haematology Internal medicine Clinical oncology
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#