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Impact of a Vitamin D Replacement Algorithm in Children and Young Adults With Acute Lymphoblastic Leukemia

Young, Jennifer, PharmD, BCOP*; Welin, Elizabeth, MS, RD, LD; Braeutigam, Carina, MD; Gilger, Elizabeth, MSN, APRN, CNP; Lane, Adam, PhD§; Salloum, Ralph, MD

Journal of Pediatric Hematology/Oncology: November 2018 - Volume 40 - Issue 8 - p 594–597
doi: 10.1097/MPH.0000000000001204
Original Articles

Background: Pediatric cancer patients have a high prevalence of vitamin D deficiency. Children and young adults with acute lymphoblastic leukemia are at high risk for associated poor bone outcomes due to contributing effects of chemotherapy and supportive care. Evidence-based vitamin D guidelines are lacking in this population.

Materials and Methods: This is a retrospective study following the implementation of an institutional guideline for standardized monitoring and supplementing vitamin D based on 25-hydroxyvitamin D levels and patient age. Goal 25-hydroxyvitamin D level was defined as ≥30 ng/mL and levels were checked every 3 months.

Results: Over a period of 22 months, 69 patients (median age, 6.7 y) were included. At diagnosis, 42 patients (60.8%) were insufficient. Among insufficient patients at diagnosis, 83.3% became sufficient at first repeat level following supplementation. At completion of the study 95.6% of patients were sufficient. Insufficiency was more common in winter than summer at baseline (74.3% vs. 47.1%, P=0.03), though the impact of seasonality was overcome following the algorithm. Throughout the study 4 patients had supratherapeutic but nontoxic levels.

Conclusions: Vitamin D replacement guidelines implemented in the pediatric and young adult acute lymphoblastic leukemia population markedly increased the percentage of vitamin D sufficient patients in a short period of time.

Divisions of *Pharmacy


Cancer and Blood Diseases Institute

§Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

E.W. is a member of the Abbott Nutrition Speaker’s Bureau. The remaining authors declare no conflict of interest.

Reprints: Jennifer Young, PharmD, BCOP, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 15010, Cincinnati, OH 45229 (e-mail:

Received December 4, 2017

Accepted April 17, 2018

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