Zie ook literatuurlijst voeding, voedingssupplementen en niet-toxische behandelingen specifiek bij stamceltransplantaties van arts-bioloog drs. Engelbert Valstar.

30 mei 2021: Bron: National Library of medicine

Wanneer kankerpatiënten met multiple myeloma (botkanker - Kahler) , en lymfklierkanker (Hodgkin- en non-Hodgkin-lymfoom) na een autologe stamceltransplantatie een maand lang 3x daags een tablet met vitamine D - calcitriol (0,25 µg) namen dan herstelden hun lymfocyten sneller dan patiënten die een placebo namen. Maar nog belangrijker de recidiefvrije overleving op 2-jaars meting was beduidend beter in vergelijking met de patiënten uit de placebogroep met 18 procent verschil in recidiefvrije overleving.

In een mediane follow-up van 29 maanden bleek de recidiefvrije overleving statistisch significant met 18 procent beter in de vitamine D - calcitriol groep (77.0%, SE = 7.0% vs. 59.0%, SE = 8.0%; P = 0.03).
De overall overleving was wel ook beter , plus 5 procent voor de vitaminegroep maar niet statistisch significant. Maar een overall overleving van 92 procent is wel goed te noemen. (87.0%, SE = 5.0% vs. 92.0%, SE = 4.0%; P = 0.72).

Dit blijkt uit een studie bij totaal 91 patiënten waarvan er 80 patiënten (leeftijd: 18-68 jaar) overbleven die door de stamceltransplantatie in volledige remissie waren gekomen en werden daarna gerandomiseerd ingedeeld in 1:1 verdeeld over twee groepen voor mediaan 29 maanden gevolgd.

Het volledige studierapport van deze studie is gratis in te zien. Klik op de titel van het abstract voor meer details en grafieken enz.

PMCID: PMC6895337

PMID: 31713184

Oral calcitriol in hematopoietic recovery and survival after autologous stem cell transplantation: a randomized clinical trial

Kosar Raoufinejad,1 Ahmad Reza Shamshiri,2 Shahrzad Pezeshki,3 Bahram Chahardouli,4 Molouk Hadjibabaie, corresponding author

1,5 Zahra Jahangard-Rafsanjani,1 Kheirollah Gholami,1,5 Mehdi Rajabi,3,6 and Mohammad Vaezi4

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Abstract

Background

Calcitriol, the active metabolite of vitamin D, is an essential regulator in the hematopoiesis and immunity. However, knowledge revealing its influence on the immune and hematologic reconstitution after hematopoietic stem cell transplantation (HSCT) in clinical trials is very limited.

Objectives

The effects of calcitriol on short-term and long-term hematopoietic recovery, relapse-free survival (RFS) and overall survival (OS) in multiple myeloma, Hodgkin’s and non-Hodgkin’s lymphoma following autologous peripheral blood HSCT were assessed.

Methods

Eighty patients (age: 18–68 years) in complete remission were allocated 1:1 to two groups by balanced block randomization. Calcitriol 0.25 μg or placebo capsule was administered three times daily from transplantation to day 30. Absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and platelet count (PC) were determined daily from transplantation to day 30. White blood cell count (WBC), PC, and hemoglobin concentration (HC) of days 180 and 365 were extracted from clinic files. A thorough examination for oral mucositis (OM) was completed daily during hospital stay. Adverse drug reactions (ADRs) as well as two-year RFS and OS were evaluated.

Results

Median time to ANC engraftment (≥0.5 × 103/μl: 10.0 vs. 11.0 days; P = 0.98) and PC engraftment (≥20.0 × 103/μl: both 14.0 days; P = 0.58) was similar between groups. However, the median time to ALC recovery was significantly shorter in the calcitriol group (≥0.5 × 103/μl: 13.0 vs. 20.0 days; P < 0.001). Moreover, ALC recovery rates on day 15 (≥0.5 × 103/μl: 82.1% vs. 42.5%; P < 0.001) and on day 30 (≥1.0 × 103/μl: 91.7% vs. 57.5%; P = 0.001) was significantly higher with calcitriol. WBC, PC, and HC on days 180 and 365 were not significantly different between groups. None of the OM indices were modulated by calcitriol. All the ADRs were non-serious and mild, possibly or unlikely related to the intervention. In a median of 29 months follow-up, RFS was significantly better in the calcitriol group (77.0%, SE = 7.0% vs. 59.0%, SE = 8.0%; P = 0.03), albeit the OS was not affected (87.0%, SE = 5.0% vs. 92.0%, SE = 4.0%; P = 0.72).

Conclusion

Calcitriol could improve ALC recovery and RFS as a safe option post-HSCT.

Conclusion

Lineage specification during hematopoiesis is a complex process where stem and progenitor cells integrate external signals from cytokine receptors and surface proteins. Calcitriol plays key roles in immunity and hematopoiesis. Calcitriol 0.25 μg capsule three times daily, from day of transplantation up to one month, is an effective and safe option for early ALC recovery and better RFS after autologous HSCT. However, the OM and OS were not improved by calcitriol in our trial. The impact of different dosage forms and doses of calcitriol on the outcomes needs further exploration. In addition, calcitriol significantly reduces the apoptosis and increases the number and activity of CD34+ cells [50]. One might argue that initiation of calcitriol prior to the collection of CD34+ cells could be a beneficial action to take.

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Acknowledgements

We greatly appreciate the participants without whom this investigational study would not be possible. We thank Ms. Ashraf Sadat Mousavi, Ms. Zahra Shahriari, BMT wards staff of Shariati Hospital, and Dr. Hamid Khoee (drug supply and randomization) for their kind assistances.

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Funding information

This study was funded through an educational grant to the researchers from the Hematology-Oncology and Stem Cell Transplantation Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

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Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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autologe stamceltransplantatie, Vitamine D, oraal calcitrol, recidiefvrije overlevingstijd