近期研究强调了维生素C和D在急性髓系白血病（AML）中的作用。在2018年，我们改变了我们的做法，为接受强化化疗的所有连续AML患者的支持性治疗中添加了这两种维生素。在本研究中，我们比较了在这种实践改变之前和之后接受治疗的患者的治疗结果。从2015年到2020年，共纳入了431名患者，其中262名未接受补充治疗，169名接受了维生素补充。维生素C和维生素D从化疗的第10天开始直到诱导和巩固期间的造血恢复期间给予。大多数患者在诊断时维生素C和D水平较低。在诱导期恢复后，维生素D水平在维C/D组中显著增加，而在移植前的水平在维C/D组与对照组相比显著较高（中位数为33 ng/mL vs. 19 ng/mL；P<0.0001）。在诱导期期间，维C/D组的细菌或真菌感染率、出血率或巨噬细胞活化综合征发生率较低，而在响应率、复发率和总生存率方面则没有差异。然而，对总生存率的多元分析显示，维C/D和NPM1突变之间存在显著的相互作用，这意味着维C/D补充与NPM1突变患者的总生存率显著相关且独立（HR为0.52；95% CI：0.30-0.90；P=0.019），而对于野生型NPM1患者（HR为1.01；95% CI：0.68-1.51；P=0.95）则没有显著影响。总之，维C/D补充是安全的，并且可能影响接受强化化疗的AML患者的治疗结果。Copyright © 2023 American Society of Hematology.

Recent studies have highlighted the role of vitamin C and D in AML. In 2018, we changed our practices to add both vitamins to the supportive care for all consecutive AML patients undergoing intensive chemotherapy. In this study, we compared the outcomes of patients treated before and after this change in practice. From 2015 to 2020, 431 patients were included, 262 of whom received no supplementation and 169 of whom received vitamin supplementation. Vitamin C and vitamin D was administered from day 10 of chemotherapy until hematologic recovery from induction and consolidation. Most patients presented at diagnosis with low levels of vitamin C and D. Upon recovery from induction, vitamin D levels among the vit C/D group significantly increased compared to diagnosis, and pre-transplant levels were significantly higher in the vit C/D group compared to the control group (median of 33 vs. 19 ng/mL; P<0.0001). During induction, the rates of bacterial or fungal infection, hemorrhage, or macrophage activation syndrome were lower in the vit C/D group, whereas there was no difference in response rate, relapse incidence, and OS. However, the multivariate analysis for OS showed a significant interaction between vitamin C/D and NPM1 mutation, meaning that vitamin C/D supplementation was significantly and independently associated with better OS in patients with NPM1 mutations (HR 0.52; 95% CI: 0.30-0.90; P=0.019) compared to wild-type NPM1 patients (HR 1.01; 95% CI: 0.68-1.51; P=0.95). In conclusion, vitamin C/D supplementation is safe and could influence the outcomes of AML patients undergoing intensive chemotherapy.Copyright © 2023 American Society of Hematology.