Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia
Vitamin D insufficiency and prognosis in chronic lymphocytic leukemia
复制标题
DOI：
10.1182/blood-2010-07-295683
复制
发表时间：
2011-02-03
期刊：
影响因子：
20.3
通讯作者：
Cerhan, James R.
中科院分区：
文献类型：
--
作者：
Shanafelt, Tait D.;Drake, Matthew T.;Cerhan, James R.
维生素D不足在全球范围内很常见，低水平与较高的癌症发病率有关。虽然维生素D不足与某些癌症的预后不良有关，但尚无慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）的数据。我们评估了参与前瞻性队列研究（发现队列）的新诊断CLL患者和参与观察性研究（确认队列）的既往未治疗患者的血清25（OH）D水平与治疗时间（TTT）和总生存期（OS）的关系。在发现队列的390例CLL患者中，119例（30.5%）为25（OH）D不足。中位随访3年后，25例（OH）D不足患者的TTT（风险比[HR] = 1.66; P = 0.005）和OS（HR = 2.39; P = 0.01）较短。在验证队列中，153例患者中有61例（39.9%）25（OH）D不足。中位随访9.9年后，25例（OH）D不足患者的TTT（HR = 1.59; P = 0.05）和OS（HR 1.63; P = 0.06）再次缩短。在对两个队列中的患者进行的汇总多变量分析中，校正了年龄、性别、Rai分期、CD 38状态、ZAP-70状态、免疫球蛋白重链可变区（IGHV）基因突变状态、CD 49 d状态和间期荧光原位杂交检测评估的细胞遗传学异常，25（OH）D不足仍然是TTT的独立预测因子（HR = 1.47; P = .008），尽管与OS的相关性不显著（HR = 1.47; P = .07）。维生素D不足与CLL患者的TTT和OS较差相关。缺乏CLL患者的维生素D水平正常化是否会改善结果值得临床测试。（血。2011; 117（5）：1492-1498）
Vitamin D insufficiency is common globally and low levels are linked to higher cancer incidence. Although vitamin D insufficiency is related to inferior prognosis in some cancers, no data exist for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). We evaluated the relationship of 25(OH) D serum levels with time-to-treatment (TTT) and overall survival (OS) in newly diagnosed CLL patients participating in a prospective cohort study (discovery cohort) and a separate cohort of previously untreated patients participating in an observational study (confirmation cohort). Of 390 CLL patients in the discovery cohort, 119 (30.5%) were 25(OH) D insufficient. After a median follow-up of 3 years, TTT (hazard ratio[HR] = 1.66; P = .005) and OS (HR = 2.39; P = .01) were shorter for 25(OH) D-insufficient patients. In the validation cohort, 61 of 153 patients (39.9%) were 25(OH) D insufficient. After a median follow-up of 9.9 years, TTT (HR = 1.59; P = .05) and OS (HR 1.63; P = .06) were again shorter for 25(OH) D-insufficient patients. On pooled multivariable analysis of patients in both cohorts adjusting for age, sex, Rai stage, CD38 status, ZAP-70 status, immunoglobulin heavy chain variable (IGHV) gene mutation status, CD49d status, and cytogenetic abnormalities assessed by interphase fluorescent in situ hybridization testing, 25(OH) D insufficiency remained an independent predictor of TTT (HR = 1.47; P = .008), although the association with OS was not significant (HR = 1.47; P = .07). Vitamin D insufficiency is associated with inferior TTT and OS in CLL patients. Whether normalizing vitamin D levels in deficient CLL patients would improve outcome merits clinical testing. (Blood. 2011; 117(5): 1492-1498)