Abstract：
OBJECTIVE: To evaluate the association between deficiency of vitamin A or D at diagnosis of pediatric acute lymphoblastic leukemia (ALL) and subsequent infectious complications during induction therapy.
METHODS: We conducted an institutional review board-approved, retrospective cohort study of children with newly diagnosed ALL from 2007 to 2017 at St. Jude Children\'s Research Hospital. We measured vitamin D, vitamin D binding protein, retinol binding protein as a surrogate for vitamin A, and immunoglobulin isotypes in serum obtained at ALL diagnosis, and we assessed the association between vitamin deficiencies or levels and infection-related complications during the 6-week induction phase using Cox regression models.
RESULTS: Among 378 evaluable participants, vitamin A and D deficiencies were common (43% and 17%, respectively). Vitamin D deficiency was associated with higher risks of febrile neutropenia (adjusted hazard ratio [aHR], 1.7; P = .0072), clinically documented infection (aHR, 1.73; P = .025), and likely bacterial infection (aHR, 1.86; P = .008). Conversely, vitamin A deficiency was associated solely with a lower risk of sepsis (aHR, 0.19; P = .027).
CONCLUSIONS: In this retrospective study, vitamin D deficiency was associated with an increased risk of common infection-related complications during induction therapy for ALL. Additional studies are warranted to evaluate whether vitamin D supplementation could mitigate this effect.
METHODS: We conducted an institutional review board-approved, retrospective cohort study of children with newly diagnosed ALL from 2007 to 2017 at St. Jude Children\'s Research Hospital. We measured vitamin D, vitamin D binding protein, retinol binding protein as a surrogate for vitamin A, and immunoglobulin isotypes in serum obtained at ALL diagnosis, and we assessed the association between vitamin deficiencies or levels and infection-related complications during the 6-week induction phase using Cox regression models.
RESULTS: Among 378 evaluable participants, vitamin A and D deficiencies were common (43% and 17%, respectively). Vitamin D deficiency was associated with higher risks of febrile neutropenia (adjusted hazard ratio [aHR], 1.7; P = .0072), clinically documented infection (aHR, 1.73; P = .025), and likely bacterial infection (aHR, 1.86; P = .008). Conversely, vitamin A deficiency was associated solely with a lower risk of sepsis (aHR, 0.19; P = .027).
CONCLUSIONS: In this retrospective study, vitamin D deficiency was associated with an increased risk of common infection-related complications during induction therapy for ALL. Additional studies are warranted to evaluate whether vitamin D supplementation could mitigate this effect.
摘要：
目的：评估小儿急性淋巴细胞白血病（ALL）诊断中维生素A或D缺乏与诱导治疗期间随后的感染并发症之间的关系。
方法：经IRB批准的，2007年至2017年在圣裘德儿童研究医院诊断为新诊断ALL的儿童的回顾性队列研究。我们测量了维生素D,维生素D结合蛋白，视黄醇结合蛋白作为维生素A的替代品，和所有诊断时获得的血清免疫球蛋白同种型，我们使用Cox回归模型评估了诱导6周期间维生素缺乏或水平与感染相关并发症之间的相关性.
结果：在378名可评估参与者中，维生素A和D缺乏是常见的(分别为43%和17%)。维生素D缺乏与高热性中性粒细胞减少症的风险相关（调整后的风险比[aHR]1.7;p=0.0072），临床记录的感染（aHR1.73；p=0.025），和可能的细菌感染（aHR1.86;p=0.008）。相反，维生素A缺乏仅与脓毒症风险降低相关(aHR0.19;p=0.027).
结论：在这项回顾性研究中，维生素D缺乏与ALL诱导治疗期间常见感染相关并发症的风险增加相关.需要进一步的研究来评估补充维生素D是否可以减轻这种影响。
方法：经IRB批准的，2007年至2017年在圣裘德儿童研究医院诊断为新诊断ALL的儿童的回顾性队列研究。我们测量了维生素D,维生素D结合蛋白，视黄醇结合蛋白作为维生素A的替代品，和所有诊断时获得的血清免疫球蛋白同种型，我们使用Cox回归模型评估了诱导6周期间维生素缺乏或水平与感染相关并发症之间的相关性.
结果：在378名可评估参与者中，维生素A和D缺乏是常见的(分别为43%和17%)。维生素D缺乏与高热性中性粒细胞减少症的风险相关（调整后的风险比[aHR]1.7;p=0.0072），临床记录的感染（aHR1.73；p=0.025），和可能的细菌感染（aHR1.86;p=0.008）。相反，维生素A缺乏仅与脓毒症风险降低相关(aHR0.19;p=0.027).
结论：在这项回顾性研究中，维生素D缺乏与ALL诱导治疗期间常见感染相关并发症的风险增加相关.需要进一步的研究来评估补充维生素D是否可以减轻这种影响。
