The Eventual Role of Donor and Recipient Vitamin D Levels in Allogeneic Hematopoetic Stem Cell Transplant Setting

Dikyar A., Hocaoğlu E., Aydın Kaynar L., Özkurt Z. N., Yegin Z. A.

The 46th Annual Meeting of the European Society for Blood and Marrow Transplantation, 29 August - 01 September 2020, vol.55, pp.422-423

  • Publication Type: Conference Paper / Summary Text
  • Volume: 55
  • Page Numbers: pp.422-423
  • Bursa Uludag University Affiliated: Yes


Background: Vitamin D (VitD), which regulates several immun system functions including hematopoietic stem cell proliferation and differentiation, may be considered to have a potential role in hematopoietic stem cell transplantation (HSCT) setting. The aim of this study was to evaluate the possible impact of donor and recipient VitD levels on HSCT outcome.

Methods: A total of 123 donor [median age: 44 (18-70) years; M/F: 66/57] and allogeneic HSCT (allo-HSCT) recipient [median age: 46 (18-68) years; M/F: 72/51] pairs were included in this retrospective study. The association of pre-HSCT VitD levels with certain HSCT parameters were analysed statistically. Subjects were classified into two subgroups, as low- (< 20 μg/L) and high-VitD (>20 μg/L) groups. Patient and transplant characteristics are summarized in Table 1.

Results: Median pre-HSCT VitD levels were 16(3-62.6) μg/L and 12.8(3-63.3) μg/L in donor and recipient groups respectively. Neutrophil engraftment day was found to be longer in low-VitD group compared to high-VitD group in allo-HSCT recipients [14(10-26) days vs 12(10-21) days; p=0.032]. A negative correlation was demonstrated between recipient VitD levels and chronic graft versus host disease (GvHD) (p=0.011, r=-0.235). Among donor and recipient arms, no statistical difference was observed between low- and high-VitD subgroups in terms of postHSCT complications including veno occlusive disease (VOD), cytomegalovirus (CMV) reactivation, mucositis, acute and chronic GvHD. At a median follow-up of 16(1- 67) months, overall survival (OS) was better in low-VitD group compared to high-VitD group in both donor [53.1% vs 49.2%, p>0.05] and recipient [60.9% vs 29.4%, p>0.05] arms, without statistical significance. On the other hand, the probability of progression free survival (PFS) was found to be higher in high-VitD group compared to low-VitD group in donor [68.4% vs 71.7%, p>0.05] and recipient [63.5% vs 72.5%, p>0.05] arms, without statistical significance. Multivariate Cox regression analysis revealed pre-HSCT European Society for Blood and Marrow Transplantation (EBMT) score (p=< 0.001), Karnofsky score (p=0.013) and VOD (p=0.002) as significant prognostic factors for OS.

Conclusions: Prevalence of VitD deficiency was shown to be extremely high among allo-HSCT recipients like healthy individuals. Based on its effects on immunological network and hematopoietic cell compartment, several studies have demonstrated a potential association of VitD with acute/chronic GvHD, CMV reactivation, post-HSCT relapse and survival. In the current study, a significant association of pre-HSCT VitD levels with neutrophil engraftment and chronic GvHD was also observed. Donor and recipient VitD levels did not represent distinct effect profiles on post-HSCT complications. However, a discordance was indicated between the impact of pre-HSCT VitD levels on OS and PFS, which did not reach statistical significance. Eventually, we can conclude that VitD requires more evidence to be considered as a potential prognostic marker in allo-HSCT setting even if remarkable data was provided in the previous reports.