(HealthDay News) — Taking vitamin C and D supplements during chemotherapy may improve some outcomes in patients with acute myeloid leukemia (AML), according to a study published in Blood Advances.
Researchers compared the outcomes of patients treated before and after a practice change of adding vitamins C and D to the supportive care of AML patients in 2018. A total of 431 patients were included — 262 who did not receive the supplements and 169 who did. Vitamins C and D were administered from day 10 of chemotherapy until hematologic recovery from induction and consolidation.
For induction, patients received idarubicin-cytarabine (n=177), idarubicin-cytarabine-lomustine (n=157), daunorubicin-cytarabine (n=71), CPX-351 (n=17), or another induction regimen (n=9). Among patients with FLT3 mutations, midostaurin was added for 1 patient in the control group and 52 patients in the vitamin C/D group. The proportion of patients who underwent allogeneic stem cell transplant in first complete remission (CR) was 33.9% in the control group and 26.1% in the vitamin C/D group.
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In the vitamin C/D group, the median plasma level of vitamin C did not change significantly from diagnosis to hematologic recovery (P =.18). However, the vitamin D level significantly increased from diagnosis to recovery from induction (P <.0001). The median pre-transplant vitamin D level was significantly higher in the vitamin C/D group than in the control group (P <.0001). At day 100 after transplant, vitamin D levels were similar between the supplement and control groups (P =.91).
Rates of certain complications during induction were lower in the vitamin C/D group than in the control group. This included grade 3-4 bacterial infections (27.2% and 35.1%, respectively; P =.086), fungal infections (10.1% vs 18.3%; P =.019), hemorrhage (1.8% vs 5.7%; P =.045), and macrophage activation syndrome (1.8% vs 8.8%; P =.002).
However, there was no significant difference between the control and supplementation groups with regard to CR or CR with incomplete hematologic recovery (CRi), death at 30 or 60 days, event-free survival (EFS), relapse-free survival (RFS), cumulative incidence of relapse (CIR), or overall survival (OS).
The rate of CR/CRi was 84.4% in the control group and 84.0% in vitamin C/D group (P =.93). The 30-day death rate was 4.2% and 2.4%, respectively (P =.31). The 60-day death rate was 8.0% and 5.9%, respectively (P =.41).
The median EFS was 17.4 months in the control group and 13.9 months in the vitamin C/D group (P =.26). The median RFS was 23.5 months and 15.5 months, respectively (P =.24). The 2-year CIR was 46.4% and 49.2%, respectively (P =.38). The median OS was 34.5 months and 30.8 months, respectively (P =.80).
A multivariate analysis for OS showed that vitamin C/D supplementation was associated with better OS in patients with NPM1 mutations (hazard ratio [HR], 0.52; 95% CI, 0.30–0.90; P =.019) but not in patients with wild-type NPM1 (HR, 1.01; 95% CI, 0.68–1.51; P =.95).
“We have shown that supplementation is feasible and safe and may help reduce some significant adverse events associated with intensive chemotherapy, which is a clear benefit for patients,” study author Christian Récher, MD, of the University Cancer Institute of Toulouse, said in a statement.
Several study authors disclosed ties to the pharmaceutical industry.
