Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia

作者：Shanafelt Tait D^*; Drake Matthew T; Maurer Matthew J; Allmer Cristine; Rabe Kari G; Slager Susan L; Weiner George J; Call Timothy G; Link Brian K; Zent Clive S; Kay Neil E; Hanson Curtis A; Witzig Thomas E; Cerhan James R

来源：Blood, 2011, 117(5): 1492-1498.

DOI：10.1182/blood-2010-07-295683

Vitamin D insufficiency is common globally and low levels are 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/SLL). 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 a median follow-up of 3 years, TTT (hazard ratio[HR] = 1.66; P = .005) and OS (HR = 2.39; P = .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 a median follow-up of 9.9 years, TTT (HR = 1.59; P = .05) and OS (HR 1.63; P = .06) were again shorter for 25(OH) D-insufficient patients. On pooled multivariable analysis of patients in both cohorts adjusting for age, sex, Rai stage, CD38 status, ZAP-70 status, immunoglobulin heavy chain variable (IGHV) gene mutation status, CD49d status, and cytogenetic abnormalities assessed by interphase fluorescent in situ hybridization testing, 25(OH) D insufficiency remained an independent predictor of TTT (HR = 1.47; P = .008), although the association with OS was not significant (HR = 1.47; P = .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. (Blood. 2011; 117(5): 1492-1498)

• 出版日期2011-2-3