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Sophia Ho
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Vitamin D Status in Hematological Stem Cell Transplant Patients at Pre-Transplant and Day +100
Names, Organizational Affiliations, and Locations of all Authors
S. Ho1, K. DaSilva1, H. Toews1, 2, J. Sarker2, D. Harding2
1School of Food and Nutritional Sciences, Brescia University College, London, ON.
2Hamilton Health Sciences, Hamilton, ON.
Patients undergoing hematopoietic stem cell transplants (HSCT) have been shown to be more likely to experience vitamin D (VD) insufficiency, which has been associated with complications in hematological malignancies (e.g., graft-versus-host-disease, poor overall survival). However, not much is known about the optimal supplementation dosage required for this patient population to achieve sufficient levels.
Objective(s)/Process or Summary of Content
The objectives of this quality assurance project were to describe the VD status of Hamilton Health Sciences (HHS) HSCT patients at pre-transplant and day +100, and to determine whether the current VD supplementation is appropriate to reach sufficiency (≥ 75 nmol/L).
Method(s)/Systemic Approach Used
A retrospective chart review was conducted on adult patients who underwent a myeloablative allogeneic HSCT at HHS between January 1, 2016, and March 31, 2021. Patients were included in the study only if their serum VD levels were measured once on admission for transplant (baseline) and once again at around day +100, and if they received vitamin D supplementation during their HSCT treatment. Variables collected include age, sex, BMI at day 0, disease type, transplant type, vitamin D supplementation prior to transplant, baseline vitamin D level, day +100 vitamin D level, graft vs host disease of the digestive tract (acute and chronic), days to sufficient vitamin D levels and days to engraftment. Data were analyzed using t tests and X 2 tests on SPSS.
One-hundred-and-fifteen patients were included in the study, where 59.1% were male and 40.9% were female with a mean age of 46.1 years. At pre-transplant, 97 (93%) patients were VD insufficient, and by day +100, only 54 (47%) patients achieved sufficient levels. Serum VD levels were found to be significantly lower at pre-transplant (M = 55.7 nmol/L, SD = 20.8) than at day +100 (M = 74.2 nmol/L, SD = 24.6) (p < 0.001). No significant differences were observed in serum VD levels at pre-transplant and day +100 in those who received a supplementation dose of 2000 IU daily. However, further analysis showed significantly higher VD levels on day +100 (M = 72.7 nmol/L, SD = 28.7) than at pre-transplant (M = 44.8 nmol/L, SD = 13.3) among those who received a VD supplementation dose of 50,000 IU weekly (p < .001).
These findings emphasize the prevalence of VD insufficiency in HSCT patients at pre-transplant and post-transplant, despite supplementation. Additionally, these results suggest that VD supplementation dosages greater than 2000 IU daily may be needed to achieve sufficient levels in the HSCT patient population.
Significance to Dietetics
With the findings from this quality assurance project, an algorithm for determining VD supplementation based on pre-transplant serum VD levels was created and has been in use by Hematology Dietitians at HHS to improve the nutritional status of patients, HSCT outcomes and, ultimately, patient care.
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