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IMPLICATION OF BASIC VALUES OF VITAMIN D IN THE CLINICAL COMPLICATIONS OF PATIENTS WITH NO HODGKIN LYMPHOMA IN ACTIVE CHEMOTHERAPY TREATMENT
Author(s):
Rafael Martos
,
Rafael Martos
Affiliations:
HEMATOLOGY,HOSPITAL GENERAL VILLALBA,COLLADO VILLALBA,Spain
Daniel Morillo
,
Daniel Morillo
Affiliations:
HEMATOLOGY,HOSPITAL GENERAL VILLALBA,COLLADO VILLALBA,Spain
Maria Yuste
,
Maria Yuste
Affiliations:
hematology,HOSPITAL GENERAL VILLALBA,COLLADO VILLALBA,Spain
Laura Bermejo
,
Laura Bermejo
Affiliations:
HEMATOLOGY,HOSPITAL UNIVERSITARIO 'INFANTA ELENA',VALDEMORO,Spain
Adriana Pascual
,
Adriana Pascual
Affiliations:
HEMATOLOGY,HOSPITAL UNIVERSITARIO 'INFANTA ELENA',VALDEMORO,Spain
Pilar Beltran
,
Pilar Beltran
Affiliations:
HEMATOLOGY,HOSPITAL UNIVERSITARIO 'INFANTA ELENA',VALDEMORO,Spain
Noelia Patrignani
,
Noelia Patrignani
Affiliations:
HEMATOLOGY,HOSPITAL UNIVERSITARIO 'INFANTA ELENA',VALDEMORO,Spain
Pilar Llamas
Pilar Llamas
Affiliations:
HEMATOLOGY,HOSPITAL UNIVERSITARIO 'FUNDACIÓN JIMENEZ DÍAZ',MADRID,Spain
(Abstract release date: 05/18/17) EHA Library. Martos Martinez R. 05/18/17; 182455; PB1741
Rafael Martos Martinez
Rafael Martos Martinez
Contributions
PDF Abstract
Abstract

Abstract: PB1741

Type: Publication Only

Background
The incidence and prevalence of Non-Hodgkin's Lymphoma B (NHL-B) has increased in recent years, reaching approximately 3-7 cases / 100,000 habitants. For this reason, the number of patients who receive chemotherapy treatment is also considerably higher; this implies a greater presence of adverse events. In many of these patients, baseline vitamin D values ​​at the time of diagnosis are decreased, and may be related to the development of the tumor pathology, also to the severity of the adverse events.

Aims
To assess the implication of vitamin D values ​​in the development of relevant clinical complications in patients diagnosed with NHL-B receiving chemotherapy. To determine its clinical evolution after correcting the vitamin deficit

Methods
Retrospective study (January2013/January2017),which includes patients diagnosed with NHL-B with histological confirmation. We analyze demographic parameters (age, sex), histological subtype of NHL-B according to WHO classification, laboratory values ​​of vitamin D (cut-off values:optimal 25-66pg/mL; low 25-18pg/mL or very low<18pg/mL), adverse effects:hematological toxicity,infection,gastrointestinal toxicity,hospital admissions and exitus.A subanalysis of complications was performed in patients with vitamin D deficiency who received corrective treatment.

Results
68patients were analyzed, and 57cases (84%) were valid because they had vitamin D determination in the 8weeks near the diagnosis. The distribution was:58% ♂(n=33)/42%♀(n=24),with median age 59years (range:29-91 years).The subtypes of LNH-B:Follicular n=23(40%),Diffuse large cell n=21(37%), Mantle n=6(11%), Marginal n=4(7%) and others n=3(5%).Patients were included in 3 groups according to serum vitamin D levels: patients with optimal levels (n=23;40%),low levels (n=27; 48%) and very low levels (n=7;12%).

Hematological toxicities were higher for the subgroup with decreased vitamin D levels vs. subgroup with level in range (28%vs72%)(p<0.01).Neutropenia was more severe (grade>2) in patients with very low levels of vitamin D(p<0.01).No patient with optimal vitamin D levels had severe anemia(Hb<8g/dl) or thrombopenia<70000/mm3, in relation to 28cases of severe toxicity diagnosed in vitamin D deficient groups. In this group were documented the two infections of the study (both pneumonias), a gastrointestinal toxicities(86%),hospitalizations for complications(69%) and only one exitus.
After treatment, it was found that 74%(n=25patients) corrected levels, presenting a lower incidence of toxicity to the treatment vs.26%(n=9) who did not correct levels and presented more complications (especially hematological toxicity) more complex and durable.

Conclusion
Vitamin D deficiency in the diagnosis of patients with NHL-B has been correlated with a higher incidence of medical complications due to the treatment of chemotherapy.

In our series, patients had greater hematological toxicity and greater severity (p <0.01), more infectious episodes and a higher hospital admission rate. These adverse effects are even more pronounced the lower the vitamin D levels (<18pg/mL).
A study conducted by Drake et al. (JCO, 2010) on 980patients presents similar data, with a significantly higher incidence of complications in vitamin D deficient patients.
After treatment with vitamin D, patients who corrected levels had a more favorable evolution with fewer hematological and infectious complications (p<0.01) in relation to those patients in whom the vitamin deficit persisted despite the treatment.
At this time, the monitoring period is not completed, so the data related to OS and SLE still have to be updated and will be presented at the next congress.
We believe that the determination of vitamin D levels should be routinely included in the diagnosis in patients with NHL-B because could be a modifiable risk factor in the complications of this patients

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): toxicity, lymphoma

Abstract: PB1741

Type: Publication Only

Background
The incidence and prevalence of Non-Hodgkin's Lymphoma B (NHL-B) has increased in recent years, reaching approximately 3-7 cases / 100,000 habitants. For this reason, the number of patients who receive chemotherapy treatment is also considerably higher; this implies a greater presence of adverse events. In many of these patients, baseline vitamin D values ​​at the time of diagnosis are decreased, and may be related to the development of the tumor pathology, also to the severity of the adverse events.

Aims
To assess the implication of vitamin D values ​​in the development of relevant clinical complications in patients diagnosed with NHL-B receiving chemotherapy. To determine its clinical evolution after correcting the vitamin deficit

Methods
Retrospective study (January2013/January2017),which includes patients diagnosed with NHL-B with histological confirmation. We analyze demographic parameters (age, sex), histological subtype of NHL-B according to WHO classification, laboratory values ​​of vitamin D (cut-off values:optimal 25-66pg/mL; low 25-18pg/mL or very low<18pg/mL), adverse effects:hematological toxicity,infection,gastrointestinal toxicity,hospital admissions and exitus.A subanalysis of complications was performed in patients with vitamin D deficiency who received corrective treatment.

Results
68patients were analyzed, and 57cases (84%) were valid because they had vitamin D determination in the 8weeks near the diagnosis. The distribution was:58% ♂(n=33)/42%♀(n=24),with median age 59years (range:29-91 years).The subtypes of LNH-B:Follicular n=23(40%),Diffuse large cell n=21(37%), Mantle n=6(11%), Marginal n=4(7%) and others n=3(5%).Patients were included in 3 groups according to serum vitamin D levels: patients with optimal levels (n=23;40%),low levels (n=27; 48%) and very low levels (n=7;12%).

Hematological toxicities were higher for the subgroup with decreased vitamin D levels vs. subgroup with level in range (28%vs72%)(p<0.01).Neutropenia was more severe (grade>2) in patients with very low levels of vitamin D(p<0.01).No patient with optimal vitamin D levels had severe anemia(Hb<8g/dl) or thrombopenia<70000/mm3, in relation to 28cases of severe toxicity diagnosed in vitamin D deficient groups. In this group were documented the two infections of the study (both pneumonias), a gastrointestinal toxicities(86%),hospitalizations for complications(69%) and only one exitus.
After treatment, it was found that 74%(n=25patients) corrected levels, presenting a lower incidence of toxicity to the treatment vs.26%(n=9) who did not correct levels and presented more complications (especially hematological toxicity) more complex and durable.

Conclusion
Vitamin D deficiency in the diagnosis of patients with NHL-B has been correlated with a higher incidence of medical complications due to the treatment of chemotherapy.

In our series, patients had greater hematological toxicity and greater severity (p <0.01), more infectious episodes and a higher hospital admission rate. These adverse effects are even more pronounced the lower the vitamin D levels (<18pg/mL).
A study conducted by Drake et al. (JCO, 2010) on 980patients presents similar data, with a significantly higher incidence of complications in vitamin D deficient patients.
After treatment with vitamin D, patients who corrected levels had a more favorable evolution with fewer hematological and infectious complications (p<0.01) in relation to those patients in whom the vitamin deficit persisted despite the treatment.
At this time, the monitoring period is not completed, so the data related to OS and SLE still have to be updated and will be presented at the next congress.
We believe that the determination of vitamin D levels should be routinely included in the diagnosis in patients with NHL-B because could be a modifiable risk factor in the complications of this patients

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): toxicity, lymphoma

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