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Impaired survival in Hodgkin's lymphoma due to vitamin D deficiency



Vitamin D metabolism plays an important role in the immune system in our body. Because Hodgkin's lymphoma develops in interaction with the immune system and studies of other lymphatic diseases have already shown evidence, researchers from the University of Cologne and Medical Medical have now investigated the relationship between vitamin D and Hodgkin's lymphoma in a new study.

Vitamin deficiency that is synonymous with poorer tumor control?

Vitamin D metabolism plays an important role in the immune system in our body. Because Hodgkin's lymphoma develops in interaction with the immune system and studies of other lymphatic diseases have already shown evidence, researchers from the University of Cologne and Medical Medical have now investigated the relationship between vitamin D and Hodgkin's lymphoma in a new study.

The team around Dr. Sven Borchmann, a researcher at Internal Medicine Clinic I, wanted to find out if vitamin D deficiency in Hodgkin's lymphoma patients is associated with poorer tumor control and, ultimately, poorer progression-free survival and overall survival. The study results were published in the prestigious Science Journal Journal of Clinical Oncology .

Vitamin D deficiency in all stages of disease

Patients with Hodgkin's lymphoma often suffer from a vitamin D deficiency, according to the first results of the experts around the first author Dr. with. BORCHMANN. As in the general population, the deficiency occurs more often in winter than in summer. It was noted that patients with vitamin D deficiency had significantly reduced progression-free survival and overall survival. This effect was independent of other relevant factors such as stage of disease or type of treatment.

Taken together, the researchers, who are also members of the German Hodgkin Study Group under the leadership of Univ.-Prof. Dr. Andreas Engert, in the study 351

patients – all participants in the clinical trials HD7, HD8 and HD9.
In 175 patients, ie half of those examined, there was vitamin D deficiency. Patients with progression or relapse had significantly lower vitamin D levels than patients without relapse (21.4 versus 35.5 nmol / L). They were also more likely to have vitamin D deficiency (68 versus 41%, P <0.0001). The researchers constantly observed this effect at all stages of the disease.

Surprisingly large differences

The final analysis showed that vitamin D deficiency is strongly associated with lower progression-free survival (HR: 2.13 [ 95%> CI: 1,84-2,48] P <0.0001). The analysis extended over an observation period of 13 years. In terms of overall survival, patients with vitamin D deficiency also had a significantly higher risk of dying (HR: 1.82 [1,53-2,15] P <0.0001).

Translated into concrete figures, this means that 81.8 percent of patients without vitamin D survived without progression in the cohort, while patients with vitamin D lacked only 64.2 percent. In terms of overall survival, 87.2 percent of patients without vitamin D deficiency were still alive after ten years, but only 76.1 percent of those with vitamin D deficiency. Upon closer examination of the causes of death of the deceased patients, vitamin D deficiency has increased the risk of dying from Hodgkin's lymphoma. Dr. Borchmann explains, "Of course, we hoped to see an effect of vitamin D deficiency on patient survival before the study started, because we assumed the difference would be so great surprised us this is only the case of studies that compare more effective with less effective chemotherapy, for example. . "

Detection of a risk factor that is easy to correct

Based on these results, the researchers conducted laboratory tests to better understand why patients with low levels of vitamin D were more likely to relapse and eventually die. In collaboration with the working group of Univ.-Prof. Dr. Dr. Roland Ullrich, Department of Internal Medicine I, was investigated in various model systems in the laboratory to the extent that vitamin D can support the treatment of Hodgkin's lymphoma with today's standard chemotherapy. It was found that the commonly administered chemotherapeutic drugs in combination with vitamin D work better. How exactly this is happening is currently the subject of further investigations.

As to the significance of the study, prof. Engert from Clinic I for Internal Medicine: "The results of the study are potentially of great relevance to the treatment of Hodgkin's lymphoma worldwide, as a risk factor identified with vitamin D deficiency is theoretically relatively easy to correct by taking appropriate preparations." the writers to be careful. It cannot be deduced directly from the study results that a correction of vitamin D deficiency will also lead to a better treatment outcome for patients with Hodgkin's lymphoma. This requires further studies that test just such a correction.

Source:
Borchmann S., Cirillo M., Görgen H., Meder L., Sasse S., Kreissl S., Bröckelmann P.J., von Tresckow B., Fuchs M., Ullrich RT, Engert A. Vitamin D deficiency is associated with impaired progression-free and survival in Hodgkin's lymphoma. Journal of Clinical Oncology 2019, October 17.
DOI: 10.1200 / JCO.19.00985


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