Prevalent Vitamin D Deficiency and Impact of Vitamin D Supplementation on Acute GVHD in HCT

2.50
Hdl Handle:
http://hdl.handle.net/10755/621513
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Prevalent Vitamin D Deficiency and Impact of Vitamin D Supplementation on Acute GVHD in HCT
Other Titles:
Global Health Promotion
Author(s):
DuPuis-Rosen, Linda; Dickson, Tara Coghlin
Lead Author STTI Affiliation:
Non-member
Author Details:
Linda DuPuis-Rosen, BSN, RN, OCN, Professional Experience: September 2005 - present- Oncology Nursing Society, Member October 2015- present- Clinical Nurse IV September 2003 - present- Oncology Certified Nurse 1985-present- BMT nurse 2009-present Co-developed “Heart to Heart” legacy tool for patients and family members 2014-present- Facilitator for weekly “Teaching for Transplant” class 2014-2006 Committee member for developing/publishing/editing a nursing reference guidebook for Hem/Onc/BMT nurses Author Summary: I have been a BMT nurse for 30 years. I have been an advocate for this patient population and have been facilitating classes and providing education materials throughout my career. Almost every week I have the a new group of patients entering into the BMT program and I have the honor of providing for them an overview of what they might expect during their BMT process.
Abstract:

Purpose:

Vitamin D, an essential hormone with function ranging from mediating bone hemostasis to immune modulation, has been reported to be deficient in the majority of myeloablative allogeneic hematopoietic cell transplant (HCT) recipients and associated with diagnosis of chronic graft versus host disease (GVHD). There are two types of GVHD (acute and chronic) which carries a high mortality rate of 34% (Grade II-IV).

Current studies continue to support the finding that there is a high prevalence of vitamin D deficiency within HCT recipients. Rosenblatt et al [1] has shown vitamin D deficiency may increase the risk of acute GVHD due to the loss of known immunomodulatory effects of vitamin D. Ganetsky [2] reported that vitamin D deficiency measured at 30 days post-HCT was associated with increased risk of grade II-IV cutaneous acute GVHD (p=0.05). Ganetsky proposed that vitamin D might confer a protective effect against cutaneous acute GVHD via reduction in CCR4 expression. The concept of a protective effect may be best illustrated by Glotzbeker [3] who reported an incidence of chronic GVHD of 63.8% at two years post transplant in HCT recipients with a vitamin D level <25ng/ml, compared to an incidence of 23.8% in recipients with higher vitamin D levels (>25ng/ml, p= 0.009).

We tested the hypothesis that vitamin D deficiency is associated with acute GVHD within 90 days after HCT.

Methods:

Fifty consecutive allogeneic recipients were selected from the HCT database based on blood samples available pre-transplant, 30 days, and 90 days post HCT over two years. To gauge the impact of vitamin D levels in the HCT, we assessed vitamin D levels at three time points, pre-transplant, day +30 and day +90, for a total of 150 samples. The bio-samples were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) for 25-OH vitamin D (D2, D3 and total). For analytical purposes vitamin D deficiency was defined as a vitamin D 25-OH level of less than 25 ng/ml. Clinical data was abstracted from the medical record with acute GVHD scoring system (already completed in patient records).

Results:

Of the 50 patients, 74% had vitamin D deficiency (median 20±8 ng/ml) pre-HCT, 86% had vitamin D deficiency at 30 days (median 16±8 ng/ml, p=.048), and remained vitamin D deficient at 90 days post HCT (median 16±10 ng/ml). Thirty percent of these 50 patients were diagnosed with Grade II-IV acute GVHD by 90 days post transplant. All patients with grade II-IV acute GVHD by 90 days had vitamin D deficiency (median 12±6 ng/ml, range 5-23ng/ml, p=.08).

Conclusion:

Given our findings as well as other recent research, it has compelled our Blood and Marrow Transplant (BMT) program to adopt a standard of care for monitoring and supplementing vitamin D. In developing our standard of care, we polled six BMT Centers across the US to identify their practice for monitoring and supplementing vitamin D. We learned that although many BMT centers were supplementing their patients, there were widely varying protocols among the centers. The frequency of vitamin D level checks were often inconsistent and the dosing for supplementation covered a wide range, and limited follow-up was reported. Implementation of the standard of care involved multiple forms of communication such as faculty meetings and updates, RN, APP and fellow in-services, RN coordinator meetings, newsletters, MD guidebook update, EPIC charting templates and smart phrases, communication between inpatient and outpatient teams, inclusion in pre and post transplant letter to referring MD. A vitamin D EPIC report was also developed to assess compliance outcomes and data analysis of adequate dosing.

Our implementation of the standard of care for monitoring and supplementing vitamin D occurred 18 months ago. We will continue to collect the data for two years to evaluate the impact of adequate vitamin D levels and its potential buffering of acute GVHD. Our hypothesis is that this new data will provide the needed evidence to elucidate the benefits of adequate vitamin D levels for the allogeneic HCT recipient population.

Keywords:
Implementation; New Standard of Care; Vitamin D
Repository Posting Date:
16-Jun-2017
Date of Publication:
16-Jun-2017
Other Identifiers:
INRC17S06
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titlePrevalent Vitamin D Deficiency and Impact of Vitamin D Supplementation on Acute GVHD in HCTen_US
dc.title.alternativeGlobal Health Promotionen
dc.contributor.authorDuPuis-Rosen, Lindaen
dc.contributor.authorDickson, Tara Coghlinen
dc.contributor.departmentNon-memberen
dc.author.detailsLinda DuPuis-Rosen, BSN, RN, OCN, Professional Experience: September 2005 - present- Oncology Nursing Society, Member October 2015- present- Clinical Nurse IV September 2003 - present- Oncology Certified Nurse 1985-present- BMT nurse 2009-present Co-developed “Heart to Heart” legacy tool for patients and family members 2014-present- Facilitator for weekly “Teaching for Transplant” class 2014-2006 Committee member for developing/publishing/editing a nursing reference guidebook for Hem/Onc/BMT nurses Author Summary: I have been a BMT nurse for 30 years. I have been an advocate for this patient population and have been facilitating classes and providing education materials throughout my career. Almost every week I have the a new group of patients entering into the BMT program and I have the honor of providing for them an overview of what they might expect during their BMT process.en
dc.identifier.urihttp://hdl.handle.net/10755/621513-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>Vitamin D, an essential hormone with function ranging from mediating bone hemostasis to immune modulation, has been reported to be deficient in the majority of myeloablative allogeneic hematopoietic cell transplant (HCT) recipients and associated with diagnosis of chronic graft versus host disease (GVHD). There are two types of GVHD (acute and chronic) which carries a high mortality rate of 34% (Grade II-IV).</p> <p>Current studies continue to support the finding that there is a high prevalence of vitamin D deficiency within HCT recipients. Rosenblatt et al [1] has shown vitamin D deficiency may increase the risk of acute GVHD due to the loss of known immunomodulatory effects of vitamin D. Ganetsky [2] reported that vitamin D deficiency measured at 30 days post-HCT was associated with increased risk of grade II-IV cutaneous acute GVHD (p=0.05). Ganetsky proposed that vitamin D might confer a protective effect against cutaneous acute GVHD via reduction in CCR4 expression. The concept of a protective effect may be best illustrated by Glotzbeker [3] who reported an incidence of chronic GVHD of 63.8% at two years post transplant in HCT recipients with a vitamin D level <25ng/ml, compared to an incidence of 23.8% in recipients with higher vitamin D levels (>25ng/ml, p= 0.009).</p> <p>We tested the hypothesis that vitamin D deficiency is associated with acute GVHD within 90 days after HCT.</p> <p><strong>Methods:</strong></p> <p>Fifty consecutive allogeneic recipients were selected from the HCT database based on blood samples available pre-transplant, 30 days, and 90 days post HCT over two years. To gauge the impact of vitamin D levels in the HCT, we assessed vitamin D levels at three time points, pre-transplant, day +30 and day +90, for a total of 150 samples. The bio-samples were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) for 25-OH vitamin D (D2, D3 and total). For analytical purposes vitamin D deficiency was defined as a vitamin D 25-OH level of less than 25 ng/ml. Clinical data was abstracted from the medical record with acute GVHD scoring system (already completed in patient records).</p> <p><strong>Results:</strong></p> <p>Of the 50 patients, 74% had vitamin D deficiency (median 20±8 ng/ml) pre-HCT, 86% had vitamin D deficiency at 30 days (median 16±8 ng/ml, p=.048), and remained vitamin D deficient at 90 days post HCT (median 16±10 ng/ml). Thirty percent of these 50 patients were diagnosed with Grade II-IV acute GVHD by 90 days post transplant. All patients with grade II-IV acute GVHD by 90 days had vitamin D deficiency (median 12±6 ng/ml, range 5-23ng/ml, <em>p</em>=.08).</p> <p><strong>Conclusion:</strong></p> <p>Given our findings as well as other recent research, it has compelled our Blood and Marrow Transplant (BMT) program to adopt a standard of care for monitoring and supplementing vitamin D. In developing our standard of care, we polled six BMT Centers across the US to identify their practice for monitoring and supplementing vitamin D. We learned that although many BMT centers were supplementing their patients, there were widely varying protocols among the centers. The frequency of vitamin D level checks were often inconsistent and the dosing for supplementation covered a wide range, and limited follow-up was reported. Implementation of the standard of care involved multiple forms of communication such as faculty meetings and updates, RN, APP and fellow in-services, RN coordinator meetings, newsletters, MD guidebook update, EPIC charting templates and smart phrases, communication between inpatient and outpatient teams, inclusion in pre and post transplant letter to referring MD. A vitamin D EPIC report was also developed to assess compliance outcomes and data analysis of adequate dosing.</p> <p>Our implementation of the standard of care for monitoring and supplementing vitamin D occurred 18 months ago. We will continue to collect the data for two years to evaluate the impact of adequate vitamin D levels and its potential buffering of acute GVHD. Our hypothesis is that this new data will provide the needed evidence to elucidate the benefits of adequate vitamin D levels for the allogeneic HCT recipient population.</p>en
dc.subjectImplementationen
dc.subjectNew Standard of Careen
dc.subjectVitamin Den
dc.date.available2017-06-16T20:35:16Z-
dc.date.issued2017-06-16-
dc.date.accessioned2017-06-16T20:35:16Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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