Vitamin D Provides Therapeutic Benefit Among Patients With MM, Review Says

A literature review revealed that supplementation with vitamin D could provide therapeutic benefits for patients with multiple myeloma (MM) who are being treated with chemotherapeutic agents.

The review, which was published in Nutrients, demonstrated the positive impact that vitamin D could have on patients with MM and outlined the remaining knowledge gaps on potential outcomes that need to be researched further.

Immune system dysfunction can play a critical role in the development and profession of MM, and studies have investigated several mechanisms and therapeutic approaches. In particular, vitamins A and D are well known for providing immune system benefits and vitamin D is thought to help prevent and support treatment for many conditions. Although there is a shortage of research on vitamin D in MM management, the researchers set out to provide a thorough analysis of existing literature on immune mechanisms and modulation of cellular growth and differentiation in response to vitamin D.

To conduct the review, the authors searched 6 scholarly databases for all in vitro studies, clinical trials, and retrospective studies the exclusively focused on MM, myeloma cell lines, and use of vitamin D, vitamin K, or any variations of those vitamins.

One study found that high vitamin D receptor (VDR) expression in breast tumors was associated with favorable prognostic factors and low breast cancer mortality risk, suggesting that high VDR expression is a positive prognostic factor. Some researchers have concluded that VDR gene polymorphisms could be considered a molecular marker of MM risk.

Another study found that low VD levels had an association with peripheral neuropathy (PN) occurrence, implying that vitamin D could have a neuroprotective effect. Additionally, the results demonstrated that PN is linked with vitamin D deficiency, which justifies the need for monitoring serum vitamin D levels and eventual supplementation. This is similar to another analysis that found that patients with vitamin D deficiency had a higher risk of PN compared with patients who were not vitamin D deficient.

“It needs to be stressed that a correlation does not prove the causative association between low vitamin D status and the occurrence and severity of PN in MM. In order to further explore this area, clinical trials should be conducted,” the researchers noted.

In vitro studies have shown that vitamin D may enhance bone lytic capabilities of malignant plasma cells in MM and that the active form of vitamin D could act on effector cells and increase the vulnerability towards anti-CD38 antibodies. However, the authors said that more evidence is needed to conclude that vitamin D supplementation could be harmful in vivo.

Clinical trials concluded that vitamin D deficiency does not impair the biochemical markers of bone metabolism in MM, prior to or after a patient receives autologous stem cell transplantation. Other clinical studies have found that vitamin D supplementation is safe in patients with MM but dosing strategies may need to be adjusted for certain patients with MM depending on their 23(OH)D3 levels.

The authors of the literature review recommended that the nonclassical actions of vitamin K and its association with vitamin D in reference to bone and cardiovascular health should be taken into consideration when deciding whether to use vitamin D supplementation in MM management. Although it’s hypothesized that the administration of vitamins D and K could lead to advanced effects in MM, there is a shortage of prospective clinical trials.

“We herein propose to conduct prospective clinical trials focusing on the supplementation vitamin D and vitamin K, including their analogs, in MM patients. We also suggest exploring the use of higher doses of vitamins than in the general population, especially in combination with novel MM drugs,” the authors suggested.

Reference

Kulig P, Łuczkowska K, Bielikowicz A, Zdrojewska D, Baumert B, Machalin ́ski B. Vitamin D as a potential player in immunologic control over multiple myeloma cells: implications for adjuvant therapies. Nutrients. Published online April 26, 2022. doi:10.3390/ nu14091802