[Mark11]

Vitamin D for peripheral neuropathy

by Mark11 on Wed Feb 24, 2016 9:43 am

I am not sure if this has been discussed previously as I do not have peripheral neuropathy and typically do not read the threads about it. There was a study that just came out that I thought I would share. I will also put the link up of a paper from 2013 that I do not think I posted previously.

I have mentioned before that I take vitamin D supplements regularly as I had extensive bone damage from the myeloma and it is used in conjunction with allogeneic (donor) stem cell transplantation to reduce the risk of graft versus host disease (GVHD) and improve immune function.

Here is the study abstract:

PURPOSE: Previous studies have shown that low serum vitamin D levels have been associated with many skeletal and non-skeletal disorders. We studied the relationship between 25-hydroxyvitamin D (25D) levels and motor and sensory peripheral neuropathy among multiple myeloma patients who have been treated with bortezomib and/or thalidomide.

METHODS: We performed a study of 111 multiple myeloma patients who had received at least one of these two agents for at least 12 weeks by correlating physical exam / neurologic assessment findings with patient self-assessment responses.

RESULTS: The median age of study patients was 66 years (range 42-89 years) and 54 % were males. 25D levels were determined, and complete history and physical and neurologic examinations were performed at the same study visit. In addition, study subjects completed questionnaires regarding symptoms related to motor and sensory peripheral neuropathy. Overall, patients had a median serum 25D level of only 32 ng/ml; 42 % of patients were considered either 25D-deficient (<20.0 ng/mL; 16 % of patients) or 25D-insufficient (20.0-29.9 ng/mL; 26 %). Notably, we found that 25D-deficient multiple myeloma patients were more likely to have severe peripheral neuropathy (>grade 2) of both motor (p = 0.0415) and sensory (p = 0.0086) types although the overall incidence of peripheral neuropathy was not higher in this patient population.

CONCLUSION: These results show that the severity of peripheral neuropathy is associated with lower vitamin D levels and provides the rationale for monitoring vitamin D for myeloma patients especially those receiving drugs associated with the development of peripheral neuropathy.

Reference:

J Wang et al, "Low serum vitamin D occurs commonly among multiple myeloma patients treated with bortezomib and/or thalidomide and is associated with severe neuropathy," Supportive Care in Cancer, Feb 2016 (abstract)

Here are some excerpts from the earlier study:

Vitamin D is a steroid hormone with a broad range of biological effects ranging from the classical role as a mediator of calcium and phosphate balance to cellular differentiation and immune modulation. These effects impact normal and dysfunctional hematopoietic and immune function, which may allow an avenue for improved treatment and support of patients suffering from hematologic disorders. In this review, we will summarize the role of vitamin D in normal hematopoiesis, discuss ways in which vitamin D may improve outcomes, and discuss a potential role of vitamin D for treating hematologic disorders and modulating the immune system to improve the outcome of allogeneic stem cell transplant ...

At the same time the role of vitamin D has been examined clinically and observationally. Badros and colleagues surveyed 100 consecutive patients seen in University of Maryland cancer center with multiple myeloma and found 75% of patients were frankly deficient or insufficient [45]. They used this information to emphasize the need for checking and supplementation, particularly as bisphosphonates that are widely recommended in multiple myeloma have never been shown to be effective without adequate calcium and vitamin D levels [45]. Additionally, attempts have been made to correlate vitamin D levels with myeloma behavior. Two observational studies from the Mayo clinic and Australia look at the clinical characteristics of vitamin D deficient myeloma patients [46,47]. Diamond and colleagues in New South Wales followed a group of myeloma patients for 10 years and stratified them into quartiles by serum vitamin D concentration. Statistically significant differences in paraprotein level and albumin concentration were seen with vitamin D quartile with lower quartiles associated with worse myeloma markers [47]. The lowest quartile also had significantly worse bone mineral density compared to the other quartiles. On the other hand, Ng and colleagues at the Mayo clinic looked at 148 newly diagnosed patients and were able to correlate 1,25-dihydroxyvitamin D levels of <50 nmol/L with lower albumin and higher CRP [46]. There was also a trend toward higher levels of vitamin D deficiency with higher staged myeloma, but there was no difference in skeletal events between the groups [46]. It should be noted that as observational studies both of these analyses cannot show causation, as it is impossible to know whether bad myeloma influences vitamin D status or vitamin D status influences myeloma behavior. Still, given the role of vitamin D in helping repair bone damage repletion is likely prudent to assure adequate repletion during treatment.

Reference:

AC Hall and MB Juckett, "The Role of Vitamin D in Hematologic Disease and Stem Cell Transplantation," Nutrients, June 2013 (full text of article)

[blueblood]

Re: Vitamin D for peripheral neuropathy

by blueblood on Wed Feb 24, 2016 1:18 pm

Mark11

Very interesting and timely. I had been taking a calcium / D3 supplement until just recently when my liver got angry and I stopped. Yesterday I received my results from my first "Vitamin D 25 Hydroxy" test (who knew there was such a test?) and it was 19.6. Pretty low.

My neuropathy is severe and in the form of numbness more so than pain - luckily. I'm sure I'll be back on D3 shortly.

Now I know why I love the sunshine

Thanks for sharing, points me in a direction.

[Cheryl G]

Re: Vitamin D for peripheral neuropathy

by Cheryl G on Fri Feb 26, 2016 11:20 am

Thanks for sharing this study, Mark.

I guess the study results raise the question of causation. Do low vitamin D levels cause peripheral neuropathy? Or does the same thing that causes people to have low vitamin D levels also makes them more likely to get peripheral neuropathy when treated with Velcade?

The only way to figure that out, I suspect, is by doing a trial to test whether giving people vitamin D reduces the incidence of peripheral neuropathy from Velcade. Do you know if such a trial has been done?

[Mark11]

Re: Vitamin D for peripheral neuropathy

by Mark11 on Sun Feb 28, 2016 12:22 pm

Hi CherylG,

Unortunately no studies that I am aware of. I was glad the study gave blood concentration levels they looked at. Many abstracts do not mention that or the dosing.

Mark