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Multiple Myeloma, Vitamin D Deficiency, and Race

Multiple myeloma cells.

In patients with multiple myeloma, vitamin D deficiency negatively impacts overall survival in white patients but not in African American patients.

Multiple myeloma is a hematologic malignancy that affects plasma cells in the bone marrow, causing damage to the immune system, surrounding organs, and bones. Because vitamin D plays a crucial role in bone health, maintaining an appropriate level of this vitamin is particularly important for patients with multiple myeloma. However, little research had been performed concerning the effect of vitamin D deficiency on survival, particularly in regard to patients' race, until now.

In a study now published in Blood Advances, a team of researchers led by Sarvari V. Yellapragada, MD, Associate Professor of Hematology/Oncology at Baylor College of Medicine in Houston, Texas, investigated the role of vitamin D deficiency on overall survival in white and African American patients with multiple myeloma. Dr. Yellapragada and colleagues evaluated the health records of 1,889 patients in the Veterans Affairs (VA) nationwide database. Of these, 61% of patients were white, 29% were African American, and 10% were of other or unknown race. Vitamin D levels were assessed within two months of multiple myeloma diagnosis, and deficiency was defined as a level of less than 20 ng/mL.

Vitamin D deficiency was observed in 46.3% of African American patients and 23.6% of white patients. In the overall study group, having a vitamin D deficiency was associated with a shorter overall survival compared with normal levels (3.10 years vs 3.91 years), with an estimated mortality risk increase of 24%. Subgroup analysis revealed additional differences based on patients' race. Overall survival was significantly lower in white patients with a vitamin D deficiency compared to those without (2.71 years vs 3.87 years), with an increased mortality risk of 38%. No statistically significant difference in survival was observed in African American patients with and without a vitamin D deficiency.

"Our study shows the importance of screening for vitamin D deficiency at diagnosis in multiple myeloma and highlights the differential effect of vitamin D across race," conclude Dr. Yellapragada and colleagues in their publication. "More studies of vitamin D deficiency in multiple myeloma are warranted to further explore the interplay between vitamin D and racial differences in its physiological impact, including potential roles in preventing tumorigenesis and promoting tumor suppression. Our results, in addition to suggesting a need to screen patients with multiple myeloma for vitamin D deficiency and consider replacement if deficient, also highlight racial differences in disease biology that require further in-depth evaluation."

For More Information

Yellapragada SV, Fillmore NR, Froloy A, et al (2020). Vitamin D deficiency predicts for poor overall survival in white but not African American patients with multiple myeloma. Blood Adv, 4(8):1643-1646. DOI:10.1182/bloodadvances.2019001411

Image credit: Michaela Reagan. Courtesy of the National Cancer Institute 

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