The following is a summary of “Association of Vitamin A and D Deficiencies with Infectious Outcomes in Children Undergoing Intensive Induction Therapy for Acute Lymphoblastic Leukemia,” published in the June 2024 issue of Pediatrics by Penkert et al.

This study aimed to assess the association between vitamin A or D deficiencies at pediatric acute lymphoblastic leukemia (ALL) diagnosis and the subsequent risk of infectious complications during induction therapy. Conducted as an IRB-approved, retrospective cohort study, it encompassed children diagnosed with newly diagnosed ALL from 2007 to 2017 at St. Jude Children’s Research Hospital. The study measured vitamin D levels, D-binding protein, retinol-binding protein (as a surrogate for vitamin A), and immunoglobulin isotypes in serum samples obtained at ALL diagnoses. Using Cox regression models, the association between these vitamin deficiencies or levels and infection-related complications during the 6-week induction phase was evaluated.

The study included 378 participants, revealing that vitamin A and D deficiencies were prevalent, affecting 43% and 17% of the cohort. The findings demonstrated that vitamin D deficiency was significantly associated with an elevated risk of febrile neutropenia (adjusted hazard ratio [aHR] 1.7; p=0.0072), clinically documented infections (aHR 1.73; p=0.025), and likely bacterial infections (aHR 1.86; p=0.008). Interestingly, vitamin A deficiency was associated with a reduced risk of sepsis (aHR 0.19; p=0.027).

In conclusion, this retrospective analysis indicates that vitamin D deficiency at ALL diagnosis is linked to an increased risk of common infection-related complications during the induction therapy phase. 

These findings suggest the potential benefits of evaluating vitamin D supplementation as a preventive strategy to mitigate infection risks in pediatric patients with ALL. Further studies are warranted to explore the efficacy of vitamin D supplementation in this context and to better understand the underlying mechanisms.

Source: sciencedirect.com/science/article/abs/pii/S0022347624002518