Screening vitamin D levels in patients with Hodgkin lymphoma (HL) and providing supplements to patients who are deficient ought to be incorporated into designing future clinical randomized trials, according to study results published in the Journal of Clinical Oncology.
Researchers measured pretreatment vitamin D levels in 351 prospectively treated patients with HL who had been enrolled in German Hodgkin Study Group clinical trials. The researchers found that 50% of patients were vitamin D deficient (< 30 nmol/L) before planned chemotherapy.
Pretreatment vitamin D deficiency was more common in patients with relapsed or refractory disease compared with matched relapse-free control individuals (68% vs 41%; P <.001). Moreover, vitamin D-deficient patients exhibited inferior progression-free survival, with a 10-year difference of 17.6% between the 2 groups (hazard ratio, 2.13; P <.001), as well as decreased overall survival, with a 10-year difference of 11.1% between the 2 groups (hazard ratio, 1.82; P <.001). These findings were consistent across trials and treatment groups, suggesting that vitamin D status is an independent predictor of survival.
The researchers performed additional experimental studies in which they supplied doses of physiologically active vitamin D (calcitriol) to cultured HL cell lines, which yielded increased antiproliferative effects in combination with chemotherapy. In an animal model, supplemental vitamin D (cholecalciferol) improved the chemosensitivity of tumors by reducing the rate of tumor growth compared with vitamin D alone or chemotherapy alone.
Until now, there have been no controlled clinical trials investigating vitamin D replacement therapy in patients with HL, and more research is warranted. Based on these findings and the limited toxicity of vitamin D replacement therapy, the researchers advocated for the incorporation of vitamin D deficiency screening and replacement into future randomized clinical trials in patients with HL.
“The goal of these trials should be to determine whether vitamin D replacement in HL improves outcomes. In the absence of such high-level, prospective evidence, treating institutions may wish to consider an individual approach to screening for vitamin D deficiency,” wrote the researchers.
1. Borchmann S, Cirillo M, Goergen H, et al. Pretreatment vitamin D deficiency is associated with impaired progression-free and overall survival in Hodgkin lymphoma [published online October 17, 2019]. J Clin Oncol. doi:10.1200/JCO.19.00985