Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma

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Abstract

We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.

Original languageEnglish (US)
Article numbere595
JournalBlood Cancer Journal
Volume7
Issue number8
DOIs
StatePublished - Aug 25 2017

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Follicular Lymphoma
Vitamin D
Confidence Intervals
Lymphoma
Odds Ratio
Survival
Treatment Failure
Disease-Free Survival
Cohort Studies
Prospective Studies
Therapeutics

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

@article{d6949eafbfd2453d88df1eb9334760c5,
title = "Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma",
abstract = "We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46{\%}) had an event (progression, treatment failure), 78 had died and 42 (6.5{\%}) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95{\%} confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95{\%}CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95{\%} CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95{\%} CI 1.26-7.13), OS (HR=2.86; 95{\%} CI 1.39-5.85), and LSS (HR=2.96; 95{\%} CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95{\%} CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95{\%} CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.",
author = "Tracy, {S. I.} and Maurer, {M. J.} and Witzig, {Thomas Elmer} and Drake, {Matthew M} and Ansell, {Stephen Maxted} and Nowakowski, {Grzegorz S} and Thompson, {Carrie A} and Inwards, {D. J.} and Johnston, {Patrick Bruce} and Ivana Micallef and C. Allmer and MacOn, {W. R.} and Weiner, {G. J.} and Slager, {Susan L} and Habermann, {Thomas Matthew} and Link, {B. K.} and Cerhan, {James R}",
year = "2017",
month = "8",
day = "25",
doi = "10.1038/bcj.2017.70",
language = "English (US)",
volume = "7",
journal = "Blood Cancer Journal",
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T1 - Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma

AU - Tracy, S. I.

AU - Maurer, M. J.

AU - Witzig, Thomas Elmer

AU - Drake, Matthew M

AU - Ansell, Stephen Maxted

AU - Nowakowski, Grzegorz S

AU - Thompson, Carrie A

AU - Inwards, D. J.

AU - Johnston, Patrick Bruce

AU - Micallef, Ivana

AU - Allmer, C.

AU - MacOn, W. R.

AU - Weiner, G. J.

AU - Slager, Susan L

AU - Habermann, Thomas Matthew

AU - Link, B. K.

AU - Cerhan, James R

PY - 2017/8/25

Y1 - 2017/8/25

N2 - We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.

AB - We evaluated whether vitamin D insufficiency (VDI; 25(OH)D <20 ng/ml) was associated with adverse outcomes among follicular lymphoma (FL) patients using an observational prospective cohort study of 642 FL patients enrolled from 2002-2012. The median age at diagnosis was 60 years. At a median follow-up of 59 months, 297 patients (46%) had an event (progression, treatment failure), 78 had died and 42 (6.5%) had a lymphoma-related death. VDI was associated with inferior event-free survival (EFS) at 12 months (EFS12, odds ratio (OR)=2.05; 95% confidence interval (CI) 1.18-3.54), overall survival (OS, hazards ratio (HR)=2.35; 95%CI 1.37-4.02), and lymphoma-specific survival (LSS, HR=2.97; 95% CI 1.52-5.80) for the full cohort. Among patients treated with immunochemotherapy (IC), VDI was associated with inferior EFS12 (OR=3.00; 95% CI 1.26-7.13), OS (HR=2.86; 95% CI 1.39-5.85), and LSS (HR=2.96; 95% CI 1.29-6.79). For observed patients, VDI was associated with inferior OS (HR=2.85; 95% CI 1.20-6.76). For other therapies, VDI was associated with inferior OS (HR=3.06; 95% CI 1.01-9.24). Our work is the first to reveal an association of VDI with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than IC. Our findings suggest a potentially modifiable prognostic factor to address in patients with FL.

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