Low 25(OH) vitamin D3 levels are associated with adverse outcome in newly diagnosed, intensively treated adult acute myeloid leukemia

BACKGROUND Several studies have suggested that low 25(OH) vitamin D ₃ levels may be prognostic in some malignancies, but no studies have evaluated their impact on treatment outcome in patients with acute myeloid leukemia (AML). METHODS Vitamin D levels were evaluated in 97 consecutive, newly diagnosed, intensively treated patients with AML. MicroRNA expression profiles and single nucleotide polymorphisms (SNPs) in the 25(OH) vitamin D₃ pathway genes were evaluated and correlated with 25(OH) vitamin D₃ levels and treatment outcome. RESULTS Thirty-four patients (35%) had normal 25(OH) vitamin D₃ levels (32-100 ng/mL), 34 patients (35%) had insufficient levels (20-31.9 ng/mL), and 29 patients (30%) had deficient levels (<20 ng/mL). Insufficient/deficient 25(OH) vitamin D₃ levels were associated with worse relapse-free survival (RFS) compared with normal vitamin D₃ levels. In multivariate analyses, deficient 25(OH) vitamin D ₃, smoking, European Leukemia Network genetic group, and white blood cell count retained their statistical significance for RFS. Several microRNAs and SNPs were associated with 25(OH) vitamin D₃ levels, although none remained significant after multiple test corrections; one 25(OH) vitamin D ₃ receptor SNP, rs10783219, was associated with a lower complete remission rate (P =.0442) and with shorter RFS (P =.0058) and overall survival (P =.0011). CONCLUSIONS It remains to be determined what role microRNA and SNP profiles play in contributing to low 25(OH) vitamin D₃ level and/or outcome and whether supplementation will improve outcomes for patients with AML. Cancer 2014;120:521-529.