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Graft-Versus-Host Disease

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

Bone Marrow Transplantation volume 50, pages 1217–1223 (2015)Cite this article

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Abstract

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.

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Authors and Affiliations

  1. Department of Medicine, Hematology Centre, Karolinska University Hospital, Stockholm, Sweden

    L von Bahr, A Björklund, K-J Malmberg, A Le Blanc, P Ljungman & K Le Blanc

  2. Division of Clinical Immunology and Transfusion Medicine, Department of Laboratory Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institutet, Stockholm, Sweden

    L von Bahr, J Alm & K Le Blanc

  3. Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden

    O Blennow

  4. Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden

    A Björklund & K-J Malmberg

  5. Department of Cancer Immunology, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway

    K-J Malmberg

  6. The KG Jebsen Center for Cancer Immunotherapy, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    K-J Malmberg

  7. Department of Internal Medicine 5, Hematology and Oncology, University of Erlangen-Nuremberg, Erlangen, Germany

    D Mougiakakos

  8. Institute of Functional Genomics, University of Regensburg, Regensburg, Germany

    P J Oefner

  9. Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France

    M Labopin

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Correspondence to L von Bahr.

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Author Contributions

LvB was the principal investigator. LvB, DM and KLB planned the study. AB and K-JM collected the patient samples. LvB, OB and ALB collected the clinical data. PJO performed the IDO analysis. ML performed the statistical analysis. LvB, JA, AB, K-JM, DM, PL and KLB analysed the results and wrote the paper. KLB takes responsibility for the integrity of the data and the accuracy of the data analysis.

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von Bahr, L., Blennow, O., Alm, J. et al. Increased incidence of chronic GvHD and CMV disease in patients with vitamin D deficiency before allogeneic stem cell transplantation. Bone Marrow Transplant 50, 1217–1223 (2015). https://doi.org/10.1038/bmt.2015.123

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