scholarly journals Vitamin D Intoxication in An Elderly: A Case Report

2019 ◽  
Vol 3 (4) ◽  
pp. 147-149
Author(s):  
Sahil Singh ◽  
Prernika Mittal ◽  
Ajay Sharma
Keyword(s):  
Vitamin D ◽  
Serum Vitamin ◽  
High Serum ◽  
Intravenous Fluids ◽  
Serum Vitamin D ◽  
Replacement Surgery ◽  
Vitamin D Intoxication ◽  
History Of ◽  
Very High

Vitamin D is a very common prescribed drug for numerous indications. Due to scarce knowledge and poor awareness of the various formulations, preparations and dosages of Vitamin D, there are many chances of prescription errors, medication errors, product use issue and undesirable adverse drug reactions. We hereby detail case of 70-year-old ex-army gentleman reported to us with a history of lethargy, confusion, reduced appetite and gait imbalance since few days with a history of knee replacement surgery 2 years back. Medical history was not of much relevance before it was revealed that he was getting cholecalciferol injection with a strength of 600000 IU once a week for few months. He was detected to have very high serum vitamin D level and hypercalcemia. He was started on intravenous fluids, diuretics and glucocorticoids. In a few days, after effective treatment, the patient was discharged in a recovering stage and advised to stop intake calcium and vitamin D in any form. At his last follow up, after a few months of discharge, he had totally recovered.

ID: 86: SAFETY OF 50,000-100,000 UNITS OF VITAMIN D3 PER WEEK IN VITAMIN D DEFICIENT, HYPERCHOLESTEROLEMIC PATIENTS, WITH STATIN INTOLERANCE

2016 ◽  
Vol 64 (4) ◽  
pp. 929.2-930
Author(s):  
V Jetty ◽  
G Duhon ◽  
P Shah ◽  
M Prince ◽  
K Lee ◽  
...  
Keyword(s):  
Vitamin D ◽  
Serum Calcium ◽  
Vitamin D3 ◽  
Serum Vitamin ◽  
Vitamin D Supplementation ◽  
High Serum ◽  
Statin Intolerance ◽  
Serum Vitamin D ◽  
Median Serum

BackgroundIn ∼85–90% of statin intolerant patients, vitamin D deficiency (serum 25 (OH) D <32 ng/ml) is a reversible cause of statin intolerance, usually requiring 50,000 to 100,000 units of vitamin D/week continuously to normalize serum vitamin D, and thus successfully allow reinstitution of statins which previously could not be tolerated because of myalgia-myositis.Specific AimIn 274 statin intolerant patients, all with low entry serum vitamin D (<32 ng/ml, median 21 ng/ml), we assessed safety and efficacy of vitamin D supplementation (50,000–100,000 units/week) over treatment periods of 3 months (n=274), 3 and 6 months (n=161), 3, 6, and 9 months (n=58), and 3, 6, 9, and 12 months (n=22).ResultsIn the 385 patients with 3 month follow-up, taking mean 61,000 and median 50,000 IU of vitamin D3/week, median serum vitamin D rose from 20 to 42 ng/ml (p<0.0001); vitamin D became high (>100 ng/ml) but not toxic-high (>150 ng/ml) in 4 patients (1.0%) (101, 102, 106, 138 ng/ml). Median serum calcium was unchanged from entry (9.6 mg/dl) to 9.6 at 3 months. On vitamin D supplementation, the trend of change in serum calcium from normal-to-high or from high-to-normal did not significantly differ (McNemar S=1.0, p=0.32), and there was no significant trend in change of the calculated glomerular filtration rate (eGFR) from entry to follow-up (McNemar S=2.6, p=0.11).In the 161 patients with 3 and 6 month follow-up, taking mean 67,000 and median 50,000 IU of vitamin D3/week, median entry serum vitamin D rose from 21 to 42 to 44 ng/ml (p<0.0001), serum vitamin D was high (>100 but <150 ng/ml) in 2 patients at 3 months (1.2%, 101, 102 mg/ml) and in 3 (1.9%) at 6 months (101, 140, 140 ng/ml). Median serum calcium was unchanged from entry (9.7 mg/dl), at 3 and 6 months (9.7, 9.6 mg/dl, p>0.05). On vitamin D supplementation, the change in serum calcium from normal-to-high or high-to-normal was no significant trend (McNemar S=0.7, p=0.41), and no trend in change of eGFR (McNemar S=1.3, p=0.26).In the 58 patients with 3, 6, and 9 month follow-up on mean and median 71,000 and 100,000 IU of D3/week, median entry vitamin D rose from 20 to 37, 41, and 44 ng/ml (p<0.0001), with 1 (1.7%, 102 ng/ml), 2 (3.5%, 140, 140 ng/ml), and 0 (0%) patients high. Median serum calcium was unchanged from entry, median 9.7, 9.8, 9.6, and 9.6 mg/dl. On vitamin D supplementation, the trend of change in serum calcium from normal-to-high or high-to-normal was not significant (McNemar S=1.8, p=0.18), and no trend in change of eGFR (McNemar S=2, p=0.16).In the 22 patients with follow-up at 3, 6, 9, and 12 months on mean and median 70,000 and 75,000 IU of D3/week, median serum vitamin D rose from 20 to 37, to 41, to 44, and to 43 ng/ml (p<0.0001), with 1 (5%, 102 ng/ml) high, 2 (9%, 140, 140) high, 0 (0%) high, and 1 (5%, 126 ng/ml) high. Serum calcium was unchanged, median at entry 9.6, and then at 3, 6, 9, and 12 months 9.7, 9.7, 9.5, and 9.7 mg/ml. At entry serum calcium was normal in 21, none high, and one became high at 12 month follow-up. The trend of change in eGFR was insignificant, McNemar S=1.0, p=0.32.When serum D rose above 100 ng/ml in the few cases, as above, it fell into the normal range within 2 weeks by reducing the vitamin D dose by 50%.ConclusionsWhen 50,000–100,000 units of vitamin D/week are given to reverse statin intolerance in statin intolerant patients with low entry vitamin D (<32 ng/ml), it appears to be safe over up to 1 year follow-up, without toxic high serum vitamin D levels >150 ng/ml, and levels rarely >100 ng/ml, and without changes in serum calcium or eGFR.

SUBLINGUAL VITAMIN D3 DRUG THERAPY IN VITAMIN D DEFICIENCY PATIENTS AT PRAVARA RURAL HOSPITAL

2019 ◽  
pp. 18-20
Author(s):  
Sanjeeva Kumar Goud T ◽  
Rahul Kunkulol
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D3 ◽  
Serum Vitamin ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Significant Difference ◽  
Before And After

The present study was aimed to study the effect of Sublingual Vitamin D3 on Serum Vitamin D level in Vitamin D deficiency patients. This was a cross-sectional and interventional study. All the Vitamin D deficiency patients of age 18-60years and either gender, willing to participate in the study were included. Patients who had greater than 20 ng/ml were excluded from the study. The total number of participants in our study was 200, out of these 111 males and 89 females, the mean age in our study was 51.07 ± 7.39Yrs. All volunteers were given sublingual vitamin D3 (60,000IU) in six doses every fifteen days of follow up for 3 months. The subject’s serum 25(OH)D levels were estimated before and after the treatment of sublingual vitamin D3. There was a statistically significant difference in serum vitamin D3 level before 16.61±6.71 ng/ml and after 35.80±7.80 ng/ml after treatment with Sublingual Vitamin D3. Six doses of 60,000IU of Vitamin D3 sublingual route having improved the role of serum 25(OH)D levels in the treatment of Vitamin D3 deficiency patients.Keywords: Vitamin D3; Sublingual route

scholarly journals Airway obstruction, serum vitamin D and mortality in a 33-year follow-up study

2018 ◽  
Vol 73 (7) ◽  
pp. 1024-1032
Author(s):  
Tiina Mattila ◽  
Tuula Vasankari ◽  
Harri Rissanen ◽  
Paul Knekt ◽  
Laura Sares-Jäske ◽  
...  
Keyword(s):  
Vitamin D ◽  
Airway Obstruction ◽  
Serum Vitamin ◽  
Serum Vitamin D ◽  
Follow Up Study

scholarly journals Association Between Vitamin D Status and Undernutrition Indices in Children: A Systematic Review and Meta-Analysis of Observational Studies

2021 ◽  
Vol 9 ◽  
Author(s):  
Chunhua Song ◽  
Hongzhi Sun ◽  
Ben Wang ◽  
Chunli Song ◽  
Hongying Lu
Keyword(s):  
Vitamin D ◽  
Observational Studies ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Serum Vitamin ◽  
High Serum ◽  
Risk Estimate ◽  
Vitamin D Status ◽  
Serum Vitamin D

Introduction: Undernutrition, defined as stunting, wasting, and underweight, still implicates millions of infants and children worldwide. Micronutrients have pivotal effects on growth rate. The outcomes of vitamin D deficiency on undernutrition indices have stayed controversial. The object of current study is to answer this question: is there any association between vitamin D status and undernutrition indices?Methods: The international databases were used for a systematic search to identify relevant observational studies in English up to January 2021. A random-effect model was applied to combine the results of included essays.Results: Among 3,400 citations, 7 observational studies (4 cohorts and 3 cross-sectional) were eligible to enter in meta-analysis. Analysis of the lowest 8,295 children indicated that low vs. high serum level of vitamin D is directly associated with a higher risk of wasting (Summary Risk Estimate: 1.30; 95% CI: 1.04, 1.62; I2 = 0%). However, there is no significant association between vitamin status and risk of stunting (Summary Risk Estimate: 1.10; 95% CI: 0.72, 1.70; I2 = 81.6%) and underweight (Summary Risk Estimate: 1.12; 95% CI: 0.81, 1.56; I2 = 49.2%).Conclusion: When comparing low and high serum vitamin D concentration categories, there is an inverse link between vitamin D status and wasting, but no relationship with stunting as well as underweight. However, further prospective and trial studies are required to deepen our understanding of these associations.

scholarly journals 5 DAY CONTINUOUS DOSING WITH ORAL NANO VIT.D3 – A CASE SERIES

2021 ◽  
Vol 8 (7) ◽  
pp. 1-4
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Serum Vitamin ◽  
Case Series ◽  
Serum Vitamin D ◽  
Severe Vitamin ◽  
Vitamin D Levels ◽  
The Impact ◽  
Continuous Dosing ◽  
Very High

Vitamin D is highly essential for various functions of human body including proper immunity. Deficiency of vitamin D is mostly undetected and also a major underlying cause for various diseases and disorders .The Prevalence of Vitamin D deficiency in India is very high, detection and immediate management of severe vitamin D deficiency is an essential step especially given the current situation of the COVID 19 Pandemic where proper immunity is an important factor for survival. This case series is an update on the impact of 5 day continuous dosing with oral Nano Vit.D3 on serum vitamin D levels in individuals with severe vitamin D deficiency without co-morbidities

scholarly journals DIETARY INTAKE AND SUN EXPOSURE RELATED TO VITAMIN D CONCENTRATION IN THALASSEMIA PATIENTS: A LITERATURE REVIEW

2021 ◽  
Vol 16 (3) ◽  
pp. 238
Author(s):  
Yesi Herawati ◽  
Gaga Irawan Nugraha ◽  
Dida Akhmad Gurnida
Keyword(s):  
Vitamin D ◽  
Literature Review ◽  
Dietary Intake ◽  
Serum Vitamin ◽  
Sun Exposure ◽  
High Serum ◽  
Liver Protein ◽  
Thalassemia Patient ◽  
Serum Vitamin D ◽  
Bone Minerals

Vitamin D has an important role in calcium homeostasis and bone minerals during rapid growth periods. Several studies have shown that deficiency of vitamin D occurs in thalassemia patient. The study used literature review to determine relation of dietary intake and sun exposure with vitamin D concentration in thalassemia patiens in 29 literatures. Those literatures were taken from books and articles published from 2010 to 2019 with the keywords “thalassemia”, “dietary intake”, “sun exposure” and “vitamin D” using database in Pubmed, Google Scholar and Medline. The results of 29 literatures showed that vitamin D deficiency is caused by reduced dietary intake and impaired vitamin D hydroxylation in the liver due to hemochromatosis resulting in high serum ferritin. Source of vitamin D comes from endogenous synthesis with sunlight exposure and little dietary source of vitamin D2 and vitamin D3. Another food intake can also affect serum vitamin D concentration, mainly fat and protein intake. Vitamin D is fat soluble vitamin, it can    be stored in the fat for later metabolized in the liver. Protein is required to transport vitamin D to blood circulation, enzyme formation and vitamin D receptor (VDR). Thalassemia patients need to increase of macro and micronutrients requirement. Low Hb concentration causes fatigue, tired easily and decreased appetite. A lot of research on thalassemia children found that intake of energy and protein were lower than recommended and lack of sun exposure. These conditions will affect to vitamin D concentration. A comprehensive understanding in the relationship of dietary intake and sun exposure to vitamin D concentration in thalassemia patients is explained in this mini review. Maintaining normal vitamin D concentration through adequate dietary intake and sun exposure are very important to optimize growth in thalassemia patients.

Vitamin D, Sun Exposure, and Lymphoma Risk.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1783-1783
Author(s):  
Jennifer L. Kelly ◽  
Jonathan W. Friedberg ◽  
Laura M. Calvi ◽  
Edwin van Wijngaarden ◽  
Susan G. Fisher
Keyword(s):  
Vitamin D ◽  
New York State ◽  
Serum Vitamin ◽  
Sun Exposure ◽  
B Cell Lymphoma ◽  
Vitamin D Insufficiency ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
History Of ◽  
Lymphoma Risk

Abstract While a large number of exogenous and endogenous factors have been examined, the etiology of most lymphoma subtypes remains largely unknown. However, recent research suggests that sunlight exposure is associated with reduced lymphoma risk. As sunlight is our major source of vitamin D, it has been suggested that increases in serum vitamin D are responsible for this association. Extra-renal activation of vitamin D results in autocrine and paracrine effects including: maintaining regulation of cell cycle proliferation, apoptosis induction, and increased cell differentiation signaling. Animal and human studies investigating the association between vitamin D and other cancers have provided support for a protective effect of vitamin D related to malignancy. We conducted a case-control study in western New York State to test the hypothesis that a history of vitamin D insufficiency increases the risk of lymphoma. Between October 2005 and September 2007, we recruited 140 newly diagnosed and previously untreated lymphoma cases and 139 clinic-based controls. Cases and controls were recruited concurrently to account for seasonal variation in vitamin D, and a serum sample and self-administered survey were collected from each subject. Current serum 25(OH)D levels were measured by radioimmunoassay (Heartland Assays Inc., Ames, IA). We used multiple linear regression to obtain quantitative estimates of past (5–10 years ago) serum vitamin D concentrations based on survey data and measured current vitamin D levels. Subsequently, we evaluated the association between estimated past vitamin D insufficiency (25(OH)D &lt; 30 ng/mL) and lymphoma risk with multiple logistic regression, controlling for the effects of age, gender, race, prior skin cancer diagnosis, known family history of lymphoma or other cancer, alcohol use, and BMI. Additionally, we examined the association between self-reported past sun exposure and lymphoma risk. The case population included 89 males (64%), 124 whites (89%), and median age was 60; the control population included 61 males (44%), 123 whites (88%), and median age was 52. Median time between case diagnosis and study participation was 21 days (5 month maximum). Cases presented predominantly with advanced stage (64% Stage III/IV) diffuse large B cell lymphoma (23%) and follicular lymphoma (32%) subtypes, and 30 (21%) cases had documented B symptoms. While serum vitamin D values ranged from 2.5 to 45.6 ng/mL, we were surprised to find that the majority of the study population (74%) was vitamin D insufficient. Those with past vitamin D insufficiency were found to have a slightly lower lymphoma risk (multivariate adjusted odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.38 – 1.23), but this result was not statistically significant. Self-reported past sunbathing (OR=0.30, 95% CI: 0.11–0.85) and past outdoor occupation (OR=0.49, 95% CI: 0.25–0.96) were statistically significantly associated with reduced lymphoma risk. This study fails to provide evidence to support an important role of vitamin D insufficiency in lymphoma etiology. However, we confirmed the previously reported decrease in lymphoma risk associated with measures of increased sun exposure, thereby supporting the validity of our study data. Moreover, our findings suggest that vitamin D insufficiency may not explain the observed association between sun and lymphoma. In light of both the high prevalence of vitamin D insufficiency and the known risk of excessive chronic sun exposure, further investigation of the risks of vitamin D insufficiency, as well as alternative pathways for the demonstrated inverse associations between sun exposure and lymphoma risk, is warranted.

Low Serum Vitamin D Levels Are Associated with Inferior Survival in Follicular Lymphoma: A Prospective Evaluation in SWOG and Lysa Studies.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2712-2712
Author(s):  
Jennifer L. Kelly ◽  
Gilles Salles ◽  
Bryan H. Goldman ◽  
Richard I Fisher ◽  
Olivier Casasnovas ◽  
...  
Keyword(s):  
Vitamin D ◽  
Follicular Lymphoma ◽  
Prognostic Significance ◽  
Serum Vitamin ◽  
B Cell Lymphoma ◽  
Serum Vitamin D ◽  
Vitamin D Levels ◽  
Pre Treatment ◽  
Anti Cd20

Abstract Abstract 2712 Introduction: While follicular lymphoma (FL) prognosis is known to be influenced by clinical characteristics and age, investigation of modifiable factors in the modern treatment era with prognostic significance has been limited. Binding of the active vitamin D metabolite to the nuclear vitamin D receptor results in autocrine and paracrine effects possibly relevant to both cancer prevention and prognosis, including regulation of cell proliferation, induction of apoptosis and differentiation, and immune modulation. Recent literature reports a potential association between high vitamin D and improved prognosis in multiple myeloma, breast and colorectal cancer, and most recently, diffuse large B cell lymphoma and chronic lymphocytic leukemia. Using stored serum from SWOG and LYSA (formerly GELA) FL trials, we evaluated the impact of pretreatment vitamin D on outcome. Methods: Subjects included in the SWOG cohort were previously untreated FL patients (pts) enrolled on one of three SWOG clinical trials (S9800, S9911, S0016) involving CHOP chemotherapy plus an anti-CD20 antibody (rituximab or I-131 tositumomab, enrolled 1998–2008); enrolled pts with pre-treatment serum stored and available through the SWOG serum banking protocol (S8947) were eligible for this analysis. Subjects included in our second independent cohort were also previously untreated FL pts enrolled on LYSA's PRIMA trial (rituximab plus chemotherapy, randomized to rituximab maintenance versus observation; enrolled 2004–2007), who had pre-treatment serum samples stored and available for serum 25(OH)D analysis. Baseline samples for both cohorts were sent to the Mayo Clinic Medical Laboratories where 25(OH)D2 and 25(OH)D3was measured directly using the gold standard liquid chromatography-tandem mass spectrometry method. Our primary endpoint was progression free survival (PFS), defined as time from date of enrollment (SWOG) or registration (PRIMA) to date of progression or death from any cause. Overall survival (SWOG enrollment/PRIMA registration to date of death from any cause) was also evaluated. Kaplan-Meier survival curves were estimated, and differences in survival time by vitamin D status were assessed using the log-rank test. Results: The SWOG cohort included 183 pts enrolled and treated in centers across the US: 55% male, 96% Caucasian, and 30% age 60 or older. Pts largely had grade 1–2 FL (90%) advanced stage (68% stage IV) FL; only 16% were poor prognosis according to IPI. Median serum 25(OH)D was 31 ng/ml. After median follow-up of 5.4 years, pts with serum 25(OH)D < 20 ng/ml (insufficiency threshold per 2010 Institute of Medicine recommendations) had significantly inferior PFS (HR 2.00, p=0.011) and OS (HR 3.57, p=0.003) as compared to those with higher levels (analyses stratified by treatment trial and adjusted for IPI). The PRIMA subset cohort included pts primarily enrolled and treated in France and Belgium: 55% male, and 39% over age 60. The majority of these pts were high risk (91% Stage III/IV, 46% ≥3 by FLIPI, 34% with B symptoms). Surprisingly, the PRIMA serum 25(OH)D distribution was notably shifted in comparison to the SWOG cohort (median 17 ng/ml). As such, we conducted the analysis in this cohort with serum 25(OH)D dichotomized at both the median (17ng/ml) and first quartile (10 ng/ml). After median follow-up of 4.5 years, pts below the median (25(OH)D <17 ng/ml) that received R-CHOP induction (n=237) had significantly inferior OS (HR 3.8, p=0.02) as compared to those with higher levels. Moreover, when dichotomized at the first quartile (10 ng/ml), PFS and OS were significantly inferior for those with lower values (PFS HR 1.73, p=0.0086; OS HR 2.7, p=0.03). Conclusions: In this international collaborative study of newly diagnosed FL pts uniformly treated with chemotherapy and anti-CD20 therapy, we report a robust association between low vitamin D levels and FL outcomes in two independent cohorts. While the threshold for sufficiency with regard to FL outcomes will need to be further defined, and may vary by population and region, the observed prognostic significance of low vitamin D for FL in this study is surprisingly strong, with OS HRs indicating a magnitude of association at or greater than the individual FLIPI prognostic factors, which we currently rely upon clinically. Moreover, serum vitamin D is the first potentially modifiable factor to be associated with FL survival. Disclosures: No relevant conflicts of interest to declare.

scholarly journals ASSOCIATION BETWEEN MATERNAL SERUM VITAMIN D AND EARLY PREGNANCY SPONTANEOUS ABORTION IN IRAQI WOMEN

2018 ◽  
Vol 11 (2) ◽  
pp. 432
Author(s):  
Ashwaq Kadhim Mohammed ◽  
Vian Hussam Almansi Alqani
Keyword(s):  
Vitamin D ◽  
Spontaneous Abortion ◽  
Early Pregnancy ◽  
Pregnancy Loss ◽  
Strong Predictor ◽  
Serum Vitamin ◽  
Maternal Serum ◽  
Childbearing Age ◽  
Serum Vitamin D ◽  
History Of

Objective: This study was aimed to estimate the Vitamin D serum concentration in a cohort of women with a history of recurrent spontaneous abortion.Methods: The current cross-sectional study was conducted at Al-Diwaniya maternity and child teaching hospital, Al-Diwaniya province, Iraq. Data collection, lab work, and procedures related to the study extended from August 2016 to August 2017. The study enrolled 42 women of childbearing age who have a history of spontaneous early pregnancy loss. From each woman, a venous sample was obtained and sent to a lab to assess serum Vitamin D concentrations using standard routine biochemical methods.Results: Assessment of mean maternal serum Vitamin D concentration revealed that the mean was 21.48±11.82 (ng/ml) and the range was from 5 to 50 (ng/ml). The number of women with low serum Vitamin D (<20 ng/ml) was 25 (approximately 60%), the results also revealed a highly negative correlation was obtained between number of abortions and maternal serum Vitamin D (r=−0.717, p<0.001) and that the value or R2 was 0.514 which indicated that the level of Vitamin D alone can act as an independent predictor to explain 51.4% of spontaneous abortions in the participating women.Conclusion: Vitamin D level is a strong predictor of pregnancy loss in early pregnancy, and that correction of Vitamin D status among Iraqi pregnant ladies may substantially reduce the frequency of spontaneous abortion.

scholarly journals Low Serum Vitamin D Levels Are Associated With Inferior Survival in Follicular Lymphoma: A Prospective Evaluation in SWOG and LYSA Studies

2015 ◽  
Vol 33 (13) ◽  
pp. 1482-1490 ◽  
Author(s):  
Jennifer L. Kelly ◽  
Gilles Salles ◽  
Bryan Goldman ◽  
Richard I. Fisher ◽  
Pauline Brice ◽  
...  
Keyword(s):  
Vitamin D ◽  
Overall Survival ◽  
Follicular Lymphoma ◽  
Serum Vitamin ◽  
Baseline Serum ◽  
Serum Vitamin D ◽  
Hazard Ratios ◽  
Vitamin D Levels ◽  
The Impact

Purpose Recent literature reports a potential association between high vitamin D and improved lymphoma prognosis. We evaluated the impact of pretreatment vitamin D on follicular lymphoma (FL) outcome. Patients and Methods SWOG participants were previously untreated patients with FL enrolled onto SWOG clinical trials (S9800, S9911, or S0016) involving CHOP chemotherapy plus an anti-CD20 antibody (rituximab or iodine-131 tositumomab) between 1998 and 2008. Participants included in our second independent cohort were also previously untreated patients with FL enrolled onto the Lymphoma Study Association (LYSA) PRIMA trial of rituximab plus chemotherapy (randomly assigned to rituximab maintenance v observation) between 2004 and 2007. Using the gold-standard liquid chromatography–tandem mass spectrometry method, 25-hydroxyvitamin D was measured in stored baseline serum samples. The primary end point was progression-free survival (PFS). Results After a median follow-up of 5.4 years, the adjusted PFS and overall survival hazard ratios for the SWOG cohort were 1.97 (95% CI, 1.10 to 3.53) and 4.16 (95% CI, 1.66 to 10.44), respectively, for those who were vitamin D deficient (< 20 ng/mL; 15% of cohort). After a median follow-up of 6.6 years, the adjusted PFS and overall survival hazard ratios for the LYSA cohort were 1.50 (95% CI, 0.93 to 2.42) and 1.92 (95% CI, 0.72 to 5.13), respectively, for those who were vitamin D deficient (< 10 ng/mL; 25% of cohort). Conclusion Although statistical significance was not reached in the LYSA cohort, the consistent estimates of association between low vitamin D levels and FL outcomes in two independent cohorts suggests that serum vitamin D might be the first potentially modifiable factor to be associated with FL survival. Further investigation is needed to determine the effects of vitamin D supplementation in this clinical setting.

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