Vitamin D levels and their associations with survival and major disease outcomes in a large cohort of patients with chronic graft-vs-host disease

Abstract

Aim To identify the factors associated with vitamin D status in patients with chronic graft-vs-host disease (cGVHD) and evaluate the association between serum vitamin D (25(OH) D) levels and cGVHD characteristics and clinical outcomes defined by the National Institutes of Health (NIH) criteria. Methods 310 cGVHD patients enrolled in the NIH cGVHD natural history study (clinicaltrials.gov: NCT00092235) were analyzed. Univariate analysis and multiple logistic regression were used to determine the associations between various parameters and 25(OH)D levels, dichotomized into categorical variables: ≤ 20 and > 20 ng/mL, and as a continuous parameter. Multiple logistic regression was used to develop a predictive model for low vitamin D. Survival analysis and association between cGVHD outcomes and 25(OH)D as a continuous as well as categorical variable: ≤ 20 and > 20 ng/mL; < 50 and ≥ 50 ng/mL, and among three ordered categories: ≤ 20, 20-50, and ≥ 50 ng/mL, was performed. Results 69 patients (22.3%) had serum 25(OH)D ≤ 20 ng/mL. Univariate analysis showed that supplement intake, nutritional status (severely malnourished, moderately malnourished, well-nourished), race (African-American, other), and estimated creatinine clearance (eCCr) were associated with 25(OH)D levels. A predictive model was developed based on supplement intake, nutritional status, race, and eCCr, accurately predicting 77.9% of patients with 25(OH) D ≤ 20 and 65.2% of those with 25(OH)D > 20 ng/mL. No association was found between vitamin D and major cGVHD characteristics, but patients with 25(OH)D ≤ 20 ng/mL had somewhat decreased survival. Conclusion Nutritional status and adequate supplementation are important to maintain 25(OH)D > 20 ng/mL in cGVHD patients. Intervention studies and more research is needed to reveal the underlying mechanism of vitamin D metabolism in cGVHD setting.