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Vitamin D status associated with early treatment failure among follicular lymphoma patients

Posted on: September 25, 2017   by  Missy Sturges & John Canell, MD


A new study discovered that low vitamin D status was associated with impaired early treatment outcome among patients with follicular lymphoma.

Follicular lymphoma (FL) occurs when a type of white blood cell, called lymphocytes, begins growing and multiplying uncontrollably. B cells and T cells are the two main types of lymphocytes that can develop into lymphomas. These cells are responsible for recognizing foreign invaders and creating antibodies to attack and kill harmful pathogens.

FL typically progresses slowly and responds well to treatment. However, this form of cancer is difficult to cure completely. As a result, researchers have begun to explore the modifiable factors that may contribute to the outcome of this disease.

Researchers suggest vitamin D may be one of these modifiable factors. Vitamin D plays an important role in cancer prevention and treatment. For instance, vitamin D has the ability to inhibit cell proliferation and facilitate cell differentiation, two key components of cancerous cell growth. In addition, vitamin D can initiate cell apoptosis, or programmed cell death, when a cell has become dysfunctional.  

Therefore, in a new study, researchers aimed to determine whether vitamin D status may impact clinical outcome among FL patients. Individuals were included in the analysis if they were at least 18 years old, a US resident and diagnosed with FL within the last 9 months at the Mayo Clinic Rochester and the University of Iowa. Individuals were excluded from the analysis if they had HIV infection or did not provide written consent to join the study.

A total of 642 patients met this criteria, and thus were included in the analysis. The patients received a blood draw at enrollment to evaluate disease state and vitamin D status. The researchers contacted the patients every 6 months for the first 3 years, followed by annual evaluations thereafter to monitor their disease progression, need for additional treatment and mortality. Participants were considered vitamin D insufficient if vitamin D levels were below 20 ng/ml.

Here is what the researchers found:

  • After 4.9 years, a total of 297 patients (46%) experienced disease progression or treatment failure. Of these patients, 78 died and 42 had a lymphoma related death.
  • Those with vitamin D levels less than 20 ng/ml experienced a 2.05 increased risk of event free survival at 12-months, 2.35 increased risk of mortality and 2.95 increased risk for lymphoma related mortality (95% CI: 1.18– 3.54, 1.37–4.02 and 1.52– 5.80, respectfully).
  • Vitamin D insufficiency was associated with increased risk of overall mortality among patients treated with chemotherapy (HR: 3.00; 95% CI 1.26–7.12).
  • For all other therapies for FL, vitamin D insufficiency was associated with a 3.06 increased risk of mortality (HR = 3.06; 95% CI 1.01–9.24).

The researchers concluded,

“Our work is the first to reveal an association of [vitamin D insufficiency (VDI)] with early clinical failure, and to demonstrate an association of VDI with adverse outcomes among patients who are observed or treated with therapies other than [immunochemotherapy].”

They went on to state,

“The results of this study support the incorporation of serum 25(OH)D measurement into routine studies performed at the time of diagnosis to help identify patients at risk of early clinical failure, as well as to inform longer term prognosis.”

The study’s strengths include the large sample size, definitive LF diagnosis and 5-year follow up period. However, since LF progresses slowly, the researchers noted that increasing the study duration would improve the strength of these findings. In addition, the observational design prevents the researchers from proving a causal relationship exists between vitamin D and LF.

Therefore, clinical trials are needed to determine whether vitamin D supplementation may improve LF outcome. However, it’s important to note that a rare form of lymphoma, called human T-cell leukemia virus type 1, may increase an individual’s risk for developing hypercalcemia. Therefore, if you have lymphoma, the Vitamin D Council recommends reaching out to your physician prior to beginning supplementation to ensure calcium levels are carefully monitored while taking vitamin D.


Sturges, M. Vitamin D status associated with adverse treatment outcome among follicular lymphoma patients. The Vitamin D Council Blog & Newsletter, 9/2017.


Tracy, S. et al. Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma. Blood Cancer Journal, 2017.

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