A randomized controlled trial testing an adherence-optimized Vitamin D regimen to mitigate bone change in adolescents being treated for acute lymphoblastic leukemia. Issue 10 (3rd October 2017)

• Record Type: Journal Article
• Authors: Orgel, Etan; Mueske, Nicole M.; Sposto, Richard; Gilsanz, Vicente; Wren, Tishya A. L.; Freyer, David R.; Butturini, Anna M.; Mittelman, Steven D.
• Is Part Of: Leukemia & lymphoma. Volume 58:Issue 10(2017)
• Page Start: 2370
• Page End: 2378
• Publication Date: 2017-10-03
• Subjects: Acute lymphoblastic leukemia -- Vitamin D -- bone mineral density -- osteopenia -- adolescent and young adult -- medication adherence; Leukemia -- Periodicals; Lymphomas -- Periodicals; 616.99419
• DOI: 10.1080/10428194.2017.1289526
• Languages: English
• ISSNs: 1042-8194

Abstract

Abstract: Adolescents with acute lymphoblastic leukemia (ALL) develop osteopenia early in therapy, potentially exacerbated by high rates of concurrent Vitamin D deficiency. We conducted a randomized clinical trial testing a Vitamin D-based intervention to improve Vitamin D status and reduce bone density decline. Poor adherence to home supplementation necessitated a change to directly observed therapy (DOT) with intermittent, high-dose Vitamin D3 randomized versus standard of care (SOC). Compared to SOC, DOT Vitamin D3 successfully increased trough Vitamin 25(OH)D levels ( p = .026) with no residual Vitamin D deficiency, 100% adherence to DOT Vitamin D3, and without associated toxicity. However, neither Vitamin D status nor supplementation impacted bone density. Thus, this adherence-optimized intervention is feasible and effective to correct Vitamin D deficiency in adolescents during ALL therapy. Repletion of Vitamin D and calcium alone did not mitigate osteopenia, however, and new, comprehensive approaches are needed to address treatment-associated osteopenia during ALL therapy.