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Bone Marrow Transplantation (2015) 50, 12171223 2015 Macmillan Publishers Limited All rights reserved 0268-3369/15
http://www.nature.com/bmt
Web End =www.nature.com/bmt
L von Bahr1,2, O Blennow3, J Alm2, A Bjrklund1,4, K-J Malmberg1,4,5,6, D Mougiakakos7, A Le Blanc1, PJ Oefner8, M Labopin9, P Ljungman1 and K Le Blanc1,2
Vitamin D has emerged as a central player in the immune system, with its deciency being implicated in the pathogenesis of several autoimmune diseases, including chronic GvHD. This is a retrospective cohort analysis of 166 patients, who underwent allogeneic hematopoietic stem cell transplantation (HSCT) at the Karolinska University Hospital, evaluating GvHD, graft failure, infectious complications and survival after HSCT in relation to pre-transplantation vitamin D levels. Most of the patients were decient in vitamin D before HSCT (median 42 nmol/L). In multivariate analysis, vitamin D level before HSCT was identied as a signicant independent risk factor for development of cGvHD. The increased incidence of cGvHD was not coupled to better disease-free survival; instead there was a trend towards lower overall survival in the vitamin D-decient patients. In addition, we found a signicant correlation between vitamin D deciency and incidence of CMV disease, with no case of CMV disease occurring in patients with sufcient levels of vitamin D before HSCT. Our results support a role of vitamin D in immune tolerance following HSCT. These ndings could be highly relevant for the care of HSCT patients, and prospective, randomized studies on the effect of
Bone Marrow Transplantation (2015) 50, 12171223; doi:http://dx.doi.org/10.1038/bmt.2015.123
Web End =10.1038/bmt.2015.123 ; published online 1 June 2015
INTRODUCTION
Allogeneic hematopoietic stem cell transplantation (HSCT) is an important and potentially curative treatment of haematological malignancies, but GvHD and infections affect outcomes.
Vitamin D has emerged as a central player in the immune system,1 affecting T and B cells, macrophages and dendritic cells (DCs).24 A vitamin D-enriched milieu maintains an immature DC phenotype associated with decreased ability to stimulate alloreactive T cells in MLCs.5 Vitamin D deciency has been associated with an increased incidence of chronic GvHD,6 and supplementation with vitamin D to induce a tolerogenic DC population has been suggested for prevention of GvHD.7 One mechanism for this maintenance of an immature DC population has been shown to be the up-regulation of indoleamine 2,3-dioxygenase (IDO),8 an enzyme converting tryptophan to kynurenine...