Authored by Dr. Brian Koffman
Bottom Line:
Taking vitamin D during watch and wait (active surveillance) extended treatment-free survival (TFS) from 84 to 169 months in all chronic lymphocytic leukemia (CLL) patients. This is a very significant statistically and clinically important improvement with a simple, inexpensive intervention. Also, during this “watch and wait” period, vitamin D supplements were shown to extend the time to first treatment (TTFT) in those with CLL who were less than 65 years old.
Who Performed the Research and Where Was it Published:
Drs. Tait Shanafelt and Sameer Parikh wrote an editorial in Blood Advances that provides informative background material and commentary on the research by Dr. Tamar Tadmor, published in the same issue of the journal vitamin D supplement for patients with early-stage chronic lymphocytic leukemia associated with longer time to first treatment.
Background:
For over a decade, we have known that those with low levels of vitamin D at the time of CLL diagnosis have worse outcomes than those who are replete (have normal levels) when diagnosed. There is also a good underlying scientific rationale to believe vitamin D might help. It’s been shown that vitamin D aids in the apoptosis (killing) of CLL cells and that CLL cells have more vitamin D receptors compared to normal B cells.
We didn’t know whether supplementing vitamin D after diagnosis would positively affect patients with the disease. As a cautionary example, in multiple sclerosis or MS, low vitamin D at diagnosis is also associated with a poorer prognosis, but supplementation did not improve disease outcomes.
Methods and Participants:
This article and interview with Dr. Shanafelt focus on the commentary on and the context of the research. Our interview with Dr. Tadmor about vitamin D in CLL provides more details on the trial’s methodology. It was a retrospective study involving an extensive Israeli electronic medical database that followed 3,474 CLL patients. Vitamin D use was defined as at least six months of supplementation.
Results:
Results are explained more in-depth in the article and interview with Dr. Tadmor. Although, some topline results include:
- 931 patients (26.8%) received vitamin D supplementation for at least six months during the active surveillance watch-and-wait period.
- Vitamin D supplements significantly lengthened TTFT in those under 65.
- Vitamin D was associated with a longer TFS for all ages.
- As a potential way to control if taking vitamin D was just a surrogate marker for a healthier lifestyle, vitamin C intake was studied and found to be of no benefit, suggesting the benefit from vitamin D was real.
Discussion and Conclusions:
In this well-designed study, we have good evidence suggesting that vitamin D supplementation taken earlier may significantly improve outcomes in CLL patients. We need to know more about the characteristics of which CLL patients might benefit most. For example, will it be those at high or low risk based on their prognostic markers? Also, because blood levels of vitamin D were not tested, we importantly don’t know if the benefit was only seen in those with low levels, to begin with, who were made replete by supplementation, or whether vitamin D might be effective in all patients.
Regardless, this is certainly encouraging research that supports the fact that a simple, inexpensive, and generally very safe early intervention can have a powerful positive impact on improving outcomes in those with chronic lymphocytic leukemia.
Links and Resources:
Watch my interview with Dr. Shanafelt below, which provides perspective on this research.
To read the actual commentary, click on the editorial in Blood Advances.
To read the research, click on Vitamin D supplement for patients with early-stage chronic lymphocytic leukemia is associated with a longer time to first treatment.
Read our article, Vitamin D Associated with Longer Treatment-Free Survival in Early CLL, which includes an interview with Dr. Tamar Tadmor, for more details about the study.
Stay strong. We are all in this together.
Brian Koffman, MDCM (retired), MS Ed
Co-Founder, Executive VP and Chief Medical Officer
CLL Society