Low plasma concentrations of retinol and α-tocopherol in hematopoietic stem cell transplant recipients: the effect of mucositis and the risk of infection

• Published in: The American journal of clinical nutrition 2002-12, Vol.76 (6), p.1358-1366
• Main Authors: High, Kevin P, Legault, Claudine, Sinclair, Jane A, Cruz, Julia, Hill, Kevin, Hurd, David D
• Format: Article
• Language: English
• Subjects: Adult; alpha-tocopherol; alpha-Tocopherol - blood; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Breast Neoplasms - surgery; Effects; Female; Health risk assessment; Herpes Zoster - blood; Humans; immune response; Infection - blood; Infections; Inflammation - blood; Leukemia - therapy; Lymphoma - surgery; Male; Medical sciences; men; Middle Aged; Mucous Membrane; multivariate analysis; patients; Plasma; risk; Risk Factors; Stem Cell Transplantation; Stem cells; Survival Rate; therapeutics; Time Factors; Tocopherols - blood; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplants & implants; vitamin A; Vitamin A - blood; vitamin deficiencies; women
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/76.6.1358

Background: Although vitamin deficiencies are rare in the United States, acute reductions in concentrations of plasma retinol (vitamin A) or alpha-tocopherol (vitamin E) have been associated with impaired immune responses in some clinical settings. Objective: The objectives were to determine the plasma concentrations of retinol and alpha-tocopherol in patients undergoing dose-intensive therapy and hematopoietic stem cell transplant and to examine the association of plasma concentrations with clinical outcomes reflecting immunity. Design: This was an observational trial of 120 consecutive recipients of hematopoietic stem cell transplant and a multivariate analysis of plasma vitamin concentrations, mucositis, infections in the first 30 d, and herpes zoster infections in the first year after hematopoietic stem cell transplant. Results: Plasma retinol and alpha-tocopherol concentrations declined from baseline to day 7, typically recovering without specific replacement toward baseline by day 14. The severity of mucositis was a strong predictor of low plasma retinol on day 7 (P = 0.001). Eighty-two patients (68%) had at least one plasma retinol concentration less than 1.05 micromol/L, a concentration previously determined to be of immunologic significance, during the peritransplant period (day −8 to day 14). Men more frequently acquired herpes zoster than women, and men who developed hyporetinolemia (≤ 1.05 μmol/L) had a significantly higher risk of herpes zoster (OR: 6.6; 95% CI: 1.5, 29.6). Plasma α-tocopherol was not associated with any clinical event measured in this study. Conclusion: Hyporetinolemia is common, particularly in subjects with severe mucositis, and is associated with an increased risk of herpes zoster infection in recipients of hematopoietic stem cell transplant. Additional investigations are required to determine whether these findings indicate a causal relation.Am J Clin Nutr 2002;76:-66.