Vitamin C deficiency in allogeneic hematopoietic cell transplantation recipients in the peri-transplant period.

PURPOSE: Hypovitaminosis C is observed in patients with hematologic malignancy, including those receiving hematopoietic cell transplantation (HCT). This study examines longitudinal vitamin C levels and inflammatory markers in patients receiving allogeneic HCT and determines the impact of treated hypovitaminosis C prior to conditioning on clinical outcomes, including mucositis.

METHODS

Adults were prospectively enrolled at the time of admission for allogeneic HCT. Clinical outcomes were compared between patients with normal vitamin C, hypovitaminosis C, and indeterminate vitamin C due to acute inflammation prior to conditioning. Patients with hypovitaminosis C were given ascorbic acid supplementation at standard dosages.

RESULTS

Sixty patients were enrolled (37 [62%] male, median age 61 years [range 22-75]), 19 (32%) with hypovitaminosis C, 28 (47%) with normal vitamin C, and 13 (22%) with indeterminate vitamin C stores due to the presence of inflammation (CRP). Patients with baseline hypovitaminosis C receiving standard dose supplementation had no difference in mucositis outcomes compared to patients with baseline normal vitamin C (adjusted odds ratio [aOR] grade III/IV mucositis=2.64 [0.44-17.96], p=0.29 and aOR hemorrhagic mucositis=0.50 [0.12-1.86], p=0.30) but did have higher odds of persistent hypovitaminosis C after discharge despite supplementation (aOR 3.71 [CI 1.05-14.22], p=0.04). Patients with high baseline CRP had higher odds of grade III/IV mucositis (aOR 8.06 [1.27-74.31], p=0.03), hemorrhagic mucositis (aOR 4.78 [1.09-25.46], p=0.04), and post-discharge hypovitaminosis C (aOR 17.80 [3.04-196.41], p=0.001).

CONCLUSION

Hypovitaminosis C is prevalent prior to allogeneic HCT. Patients with hypovitaminosis C treated with standard ascorbic acid repletion had no difference in clinical outcomes compared to patients with normal vitamin C levels; however, repletion was not sufficient to restore normal vitamin C levels. Patients with high baseline CRP and thus indeterminate vitamin C stores had worse clinical outcomes overall including severe mucositis. Optimal timing and dosing of vitamin C supplementation should be determined.