Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 9; pp. 1217 - 1223
• Main Authors: von Bahr, L, Blennow, O, Alm, J, Björklund, A, Malmberg, K-J, Mougiakakos, D, Le Blanc, A, Oefner, P J, Labopin, M, Ljungman, P, Le Blanc, K
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-09-2015; Nature Publishing Group
• Subjects: 692/308/174; 692/499; Adult; Allografts; Analysis; Autoimmune diseases; Bone marrow; Calciferol; Care and treatment; Cell Biology; Chronic Disease; Complications; Complications and side effects; Cytomegalovirus; Cytomegalovirus infections; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - therapy; Dietary supplements; Disease; Female; Graft rejection; Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Graft vs Host Disease - therapy; Graft vs. host disease; Graft-versus-host reaction; Grafts; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Immune system; Immunological tolerance; Incidence; Internal Medicine; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neoplasms - epidemiology; Neoplasms - therapy; original-article; Pathogenesis; Patients; Public Health; Risk analysis; Risk factors; Stem cell transplantation; Stem Cells; Survival; Transplantation; Vitamin D; Vitamin D deficiency; Vitamin D Deficiency - complications; Vitamin D Deficiency - epidemiology; Vitamin D Deficiency - therapy; Vitamin deficiency; Sweden
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/bmt.2015.123

Vitamin D has emerged as a central player in the immune system, with its deficiency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were deficient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identified as a significant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-deficient patients. In addition, we found a significant correlation between vitamin D deficiency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufficient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These findings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of vitamin D supplementation are therefore needed.