Interventions to combat Vitamin D Deficiency in patients undergoing Hematopoietic Stem Cell Transplantation

Introduction: Patients undergoing Hematopoietic Stem Cell Transplantation(HSCT) may have low vitamin D (VD) level because of decreased exposure to sunlight, the major cause of VD Deficiency (VDD), from prolonged hospital stays, limited outdoor activity, and sunscreen use, and decreased oral intake caused by gastrointestinal treatment toxicity. Besides that gastrointestinal graft-versus-host disease (GVHD) limit absorption of VD. Some medications received during the HSCT can increased the VD catabolism, and alterate renal and kidney function.

Objectives: To evaluate the reduction of number of patients with VD Deficiency in patients undergoing HSCT after educational classes for the multi-professional team (physicians, dietitians and nurses).

Methods: We analyzed 72 patients undergoing HSCT May 2012 to January 2014 in the Hematology-Oncology and Bone Marrow Transplantation Center at Albert Einstein Hospital in São Paulo, Brazil. The serum levels of vitamin were measured in the first day of hospitalization of the patients adults (>= 18 years) who would be undergoing HSCT. All types of HSCT patients were included.We used in our study the VDD was defined and recommended by the Institute of Medicine as a 25(OH)D <=20 ng/ml, VD insufficiency of 21-29 ng/ml, and VD normal >=30 ng/ml.In the 2012 the multi-professional HSCT Team had 3 classes about VD and, everyone were informes about the VD research protocol.

Results: 72 adult patients were observed in this study, aged between 18 and 74 years, with the majority (77.8%) with less than 65 years. Of the total, 59.7% were men and 41.7% had normal body mass index. 100% of the lymphoma patients had VDD. In 2012(n:33), 60% patients had VDD and in 2013 (n:39), 40% (p<0,05).

Conclusions: When all of members of HSCT team were informed about the benefits of high VD levels in patients undergoing HSCT by classes and research protocol, we can reduce VDD.