By Paul Kleutghen | Posted - Aug 10th, 2020

 

 

 

 

Vitamin D Levels Impact Myeloma Patient Outcomes After Transplant

The Myeloma Crowd published a post a few months ago summarizing a study that indicated the benefit of ‘normal’ Vitamin D levels in circulating plasma on the outcomes of autologous stem cell transplant for myeloma patients. The journal Hematological Oncology has just published the results of a Swiss study that provides additional confirmation that appropriate levels of Vitamin D have a beneficial impact on disease progression of multiple myeloma patients after auto-SCT.

There have been a number of publications that have reported that patients with hematological malignancies undergoing allo-SCT have typically fared better in both Overall Survival (OS) and Progression Free Survival (PFS) when their Vitamin D levels were at normal or above normal levels. There is precious little literature available, though, about the impact normal Vitamin D levels have on OS and PFS of patients undergoing auto-SCT’s. The paper referenced above provides outcomes of a six-year study that tracked patients through their treatment journey from diagnosis to post auto-SCT. The results for myeloma patients are worth noting and being aware of:

  • In the myeloma patients [median] PFS was longer in the normal VitD patients as compared to the low VitD patients (median 19.5 months vs. 16.0 months).’
  • Median OS [of myeloma patients] was 21.4 months in patients with normal VitD as compared to 20.4 months in patients with low VitD.’

You may look at these comparisons and say, ‘Big whoop ! I don’t see much of a difference.’ Technically you are somewhat correct, but I encourage you to click on the above referenced link and look at the Kaplan-Meier curves for the myeloma group (right hand side, top of page 5 of the article) and you will see how the OS and PFS curves diverge rapidly for the two different Vitamin D patient groups. For example, mortality in the first two years of treatment was near 0 % in the normal Vitamin D group and ran about 20 % in the low Vitamin D group.

The authors make several comments worth noting :

  • … VitD levels were demonstrated to have an independent prognostic impact on overall survival [with a degree of certainty of + 98 %]. With the increase of VitD levels by one unit (nmol/L), the risk of death was reduced by 2 %.’
  • It is tempting to correct low VitD levels [before auto-SCT], particularly since this is an easy and inexpensive intervention with a favorable toxicity profile.’

A final note for those who choose to read the article and then compare their own Vitamin D lab results against what is considered ‘normal’ in this article. The authors use a measure of Vitamin D levels expressed as nmol/L (nano moles per liter). This is how Vitamin D results are typically expressed in Europe and their cut-off point between low and normal levels is 52 nmol/L. Vitamin D results in the US are typically expressed as ng/mL (nano-grams per milliliter) with a standard range of 30-100 ng/ml (<10 ng/ML is deficiency, 10-30 ng/ml is insufficiency, 30-100 ng/mL is sufficiency, >100 mL is toxicity). I have therefore two items of caution:

  • You cannot start to blindly compare your ownVitamin D lab results expressed in ng/mL to this European cutoff point expressed in nmol/L. You need to work this through with your physician.
  • Please do not rush to Costco to buy this gallon jug of Vitamin D capsules and start popping them like candy. Vitamin D is not cleared out of the body as rapidly as other vitamins like Vitamin C. Vitamin D builds up and there is a point where it becomes toxic to humans. I am sure that when your physician prescribes a course of Vitamin D treatment, he/she will also monitor several times per year that you will remain within a healthy, acceptable range of Vitamin D in your plasma.
 
Paul Kleutghen
About the Author

Paul Kleutghen - I am a patient diagnosed in 2014 with primary plasma cell leukemia (pPCL), a rare and aggressive variant of multiple myeloma and have been very fortunate to find treatment at the division of Cellular Therapy at the Duke University Cancer Institute. My wife, Vicki, and I have two adult children and a grandson who is the ‘light of my life’. Successful treatment has allowed Vicki and I to do what we love best : traveling the world, albeit it with some extra precautions to keep infections away. My career in the pharmaceutical industry has given me insights that I am currently putting to use as an advocate to lower drug pricing, especially prices for anti-cancer drugs and, very specifically, CAR-T therapies, with recent contributions posted by Health affairs, the Institute for Clinical and Economic Review and the Centers for Medicare and Medicaid Services.

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Karon - Thank you that was interesting to read.

Paul - Now I know why my doctor, prof Thomas Pabst, prescribed vitamin D drops!

 

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