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November 9, 2010

Leukemia patients with insufficient vitamin D levels face earlier mortality risk

Leukemia patients with insufficient vitamin D levels face earlier mortality risk

A report published online on November 3, 2010 in the journal Blood reveals an increased risk of rapid disease progression and earlier mortality in chronic lymphocytic leukemia (CLL) patients who had insufficient vitamin D levels.

Hematologist Tait Shanafelt, MD and his colleagues at the Mayo Clinic and the University of Iowa evaluated the blood of 390 newly diagnosed chronic lymphocytic leukemia patients for plasma 25-hydroxyvitamin D. Thirty percent of the participants were found to have insufficient levels of less than 25 nanograms per milliliter (ng /mL). Following a median follow-up of three years, an association was observed between decreasing vitamin D levels and shorter intervals between diagnosis and cancer progression, as well as reduced survival. Participants whose vitamin D levels were insufficient had a 66 percent greater risk of disease progression necessitating chemotherapy and more than double the risk of dying than those with sufficient levels. A separate analysis of 153 untreated chronic lymphocytic leukemia patients followed for a decade supported the findings.

"This tells us that vitamin D insufficiency may be the first potentially modifiable risk factor associated with prognosis in newly diagnosed CLL," Dr Shanafelt announced. "This finding may be particularly relevant for this kind of leukemia because although we often identify it at an early stage, the standard approach is to wait until symptoms develop before treating patients with chemotherapy. This watch and wait approach is difficult for patients because they feel there is nothing they can do to help themselves."

"Between one-fourth and one-half of patients seen in routine clinical practice have vitamin D levels below the optimal range, and it is estimated that up to 1 billion people worldwide have vitamin D insufficiency," he noted. "It is simple for patients to have their vitamin D levels checked by their physicians with a blood test. And if they are deficient, vitamin D supplements are widely available and have minimal side effects."

"Vitamin D insufficiency is associated with inferior time to treatment and overall survival in CLL patients," the authors conclude. "Whether normalizing vitamin D levels in deficient CLL patients would improve outcome merits clinical testing."

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Leukemia

Leukemia can be classified into four major types based on whether the disease is acute or chronic and according to the type of white blood cell affected:

  • Acute myelogenous leukemia (AML)
  • Chronic myelogenous leukemia (CML)
  • Acute lymphocytic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)

Myelogenous leukemia involves myeloid cells, granulocytes (neutrophils, basophils, and eosinophils) and monocytes (macrophages). Lymphocytic leukemia involves T and B cells (lymphocytes).

Suboptimal levels of micronutrients can cause DNA damage associated with leukemia and limit the ability to repair this damage (Ames BN 1998; Ames BN 1999).

Epigallocatechin from green tea, curcumin from turmeric, and genistein from soy extracts have all been shown to block the production of growth factors such as VEGF (Arbiser JL et al 1998; Carlo-Stella C et al 1996b; Lee YK et al 2004) typically seen in high levels in CLL (Ferrajoli A et al 2001). Essential fatty acids have been shown to suppress other inflammatory factors, such as IL-6 and TNF-alpha that are seen in high levels in CLL (De CR et al 2000; Purasiri P et al 1997).

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