Clinical and molecular characteristics associated with Vitamin C deficiency in myeloid malignancies; real world data from a prospective cohort

Vitamin C is an essential vitamin that acts as a co-factor for many enzymes involved in epigenetic regulation in humans. Low vitamin C levels in hematopoietic stem cells (HSC) promote self-renewal and vitamin C supple-mentation retards leukaemogenesis in vitamin C-deficient mouse models. Studies on vitamin C levels in patients with myeloid malignancies are limited. We thus conducted a retrospective analysis on a prospective cohort of patients with myeloid malignancies on whom plasma vitamin C levels were measured serially at diagnosis and during treatment. Baseline characteristics including hematological indices, cytogenetics, and molecular muta-tions are described in this cohort. Among 64 patients included in our study, 11 patients (17%) had low vitamin C levels. We noted a younger age at diagnosis for patients with myeloid malignancies who had low plasma vitamin C levels. Patients with low plasma vitamin C levels were more likely to have acute myeloid leukemia compared to other myeloid malignancies. Low vitamin C levels were associated with ASXL1 mutations. Our study calls for further multi-institutional studies to understand the relevance of low plasma vitamin C level in myeloid neo-plasms, the role of vitamin C deficiency in leukemogenesis, and the potential benefit of vitamin C supplementation.

Automated summary

Vitamin C is crucial for epigenetic regulation and its deficiency can promote leukemogenesis. Limited studies have investigated vitamin C levels in patients with myeloid malignancies. In this study, we retrospectively analyzed a prospective cohort and found that 17% of patients had low vitamin C levels, which were associated with younger age at diagnosis, increased risk of acute myeloid leukemia, and ASXL1 mutations. Further multi-institutional studies are needed to understand the relevance and potential benefits of vitamin C supplementation in myeloid neoplasms.