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Lugano 2013: Vitamin D Deficiency Associated with Worse Outcome in Elderly Patients with Aggressive B-cell Lymphoma Receiving R-CHOP or CHOP

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Key Points

  • Vitamin D deficiency was common in elderly patients with diffuse large B-cell lymphoma.
  • Vitamin D levels ≤ 8 ng/mL were associated with poorer event-free survival and overall survival in patients receiving R-CHOP and poorer overall survival in those receiving CHOP without rituximab.
  • The stronger adverse effect of vitamin D deficiency in patients receiving rituximab suggests that vitamin D deficiency may interfere with rituximab activity.

Vitamin D deficiency recently was shown to be associated with worse outcome in patients with non-Hodgkin lymphoma. To determine whether such an association exists in patients with aggressive B-cell lymphoma, Jörg T. Bittenbring, of Saarland University Medical School, Germany, and colleagues in the German High-Grade Non-Hodgkin Lymphoma Study Group analyzed the relationship between serum vitamin D levels and outcome in elderly patients with diffuse large B-cell lymphoma receiving CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or R-CHOP (CHOP plus rituximab [Rituxan]). Vitamin D deficiency was associated with significantly reduced event-free survival and overall survival in patients receiving R-CHOP and significantly reduced overall survival in those receiving CHOP.

The findings, the results of the RICOVER-60 trial, were reported at the 12th International Conference on Malignant Lymphoma in Lugano, Switzerland (Abstract 103), and at the 2013 ASCO Annual Meeting in Chicago (Abstract 8569).

In the study, 25-OH vitamin D serum levels were measured by chemoluminescence immunoassay in elderly patients receiving six or eight cycles of CHOP with or without rituximab. Of 359 patients, 193 (54%) had vitamin D deficiency (< 10 ng/mL) and 165 (46%) had vitamin D insufficiency (10–30 ng/mL).

Effect of Vitamin D Deficiency on Survival Outcomes

Among patients receiving R-CHOP, those with serum vitamin D levels ≤ 8 ng/mL had 3-year event-free survival of 59% and 3-year overall survival of 70% compared with 79% and 82%, respectively, in patients with vitamin D levels > 8 ng/mL. In a multivariate analysis adjusting for International Prognostic Index risk factors, these differences were significant for both event-free survival (hazard ratio [HR] = 2.1, P = .008) and overall survival (HR = 1.9, P = .040).

In multivariate analysis among patients receiving CHOP without rituximab, those with vitamin D levels ≤8  ng/mL had a significantly poorer overall survival (HR = 1.8, P = .025) but not event-free survival (HR = 1.2, P = .388) compared with those with higher vitamin D levels. The results were confirmed in an independent validation set of 63 patients in the prospective RICOVER-no-Rx study.

As stated by the investigators, “Vitamin D deficiency is associated with a significantly worse outcome of patients with diffuse large B-cell lymphoma treated with R-CHOP. The stronger adverse effect of vitamin D deficiency in patients receiving rituximab suggests that vitamin D deficiency interferes with the mechanisms of action of this antibody. A prospective study evaluating the effects of vitamin D [supplementation] on outcome of patients receiving R-CHOP is warranted.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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