异基因骨髓移植（BMT）后移植相关死亡率（TRM）的早期预测指标：血尿素氮（BUN）和胆红素。

Early predictors of transplant-related mortality (TRM) after allogeneic bone marrow transplants (BMT): blood urea nitrogen (BUN) and bilirubin.

作者信息

Bacigalupo A, Oneto R, Bruno B, Soracco M, Lamparelli T, Gualandi F, Occhini D, Raiola A, Mordini N, Berisso G, Bregante S, Dini G, Lombardi A, Lint M V, Brand R

机构信息

Divisione Ematologia II Ospedale San Martino, Genova, Italy.

出版信息

Bone Marrow Transplant. 1999 Sep;24(6):653-9. doi: 10.1038/sj.bmt.1701953.

DOI:10.1038/sj.bmt.1701953

PMID:10490732

Abstract

Transplant-related mortality (TRM) following allo- geneic bone marrow transplantation (BMT) remains a major concern and early identification of patients at risk may be clinically relevant. In this study we describe a predictive score based on bilirubin and blood urea nitrogen (BUN) levels on day +7 after BMT. The patient population consisted of 309 consecutive patients who underwent BMT from sibling (n = 263) or unrelated donors (n = 46) for hematologic disorders between December 1990 and December 1996. Of 27 laboratory tests taken on day +7 after BMT, serum bilirubin (P = 0.02) and BUN (P = 0.007) were found to be independent predictors of TRM in multivariate analysis. The median levels of bilirubin (0.9 mg/dl) and of BUN (21 mg/dl) were then used as a cut-off and a score of 1 was given for values equal/greater than the median. There were 216 patients with scores 0-1 (low risk) on day +7 (bilirubin <0.9 and/or BUN <21) and 93 patients with score 2 (high risk) (bilirubin >/=0.9 and BUN >/=21): the latter had more grade III-IV acute graft-versus-host disease (P = 0.03), slower neutrophil (P = 0.02) and slower platelet engraftment (P = 0.002). The actuarial 5 year TRM is 22% for low risk vs44% for high risk patients (P = 0.0003). For HLA-identical siblings TRM is 20% vs35% (P = 0.01), for unrelated donors it is 20% vs 65% (P = 0.01). Day +7 score was highly predictive of TRM on multivariate analysis (hazard ratio 1.9, P < 0.01), after adjustment for year of transplant (P < 0.00001), unrelated vs sibling donors (P = 0.001), patient age (P = 0.01) and diagnosis (P = 0.01). These results were validated on an independent group of 82 allogeneic BMT recipients in a pediatric Unit who showed an actuarial TRM of 16% for low risk vs 46% for high risk patients (P = 0.002). This study suggests that it may be possible to identify patients with different risks of TRM on day +7 after BMT: high risk patients could be eligible for programs designed to intensify prophylaxis of post-transplant complications.

摘要

异基因骨髓移植（BMT）后的移植相关死亡率（TRM）仍是一个主要问题，早期识别有风险的患者可能具有临床意义。在本研究中，我们描述了一种基于BMT后第7天胆红素和血尿素氮（BUN）水平的预测评分。患者群体包括1990年12月至1996年12月期间因血液系统疾病接受来自同胞（n = 263）或无关供者（n = 46）BMT的309例连续患者。在BMT后第7天进行的27项实验室检查中，血清胆红素（P = 0.02）和BUN（P = 0.007）在多变量分析中被发现是TRM的独立预测因素。然后将胆红素的中位数水平（0.9mg/dl）和BUN的中位数水平（21mg/dl）用作临界值，对于等于/高于中位数的值给予1分。在第7天有216例患者评分为0 - 1分（低风险）（胆红素<0.9且/或BUN<21），93例患者评分为2分（高风险）（胆红素≥0.9且BUN≥21）：后者有更多III - IV级急性移植物抗宿主病（P = 0.03），中性粒细胞恢复较慢（P = 0.02），血小板植入较慢（P = 0.002）。低风险患者的5年精算TRM为22%，高风险患者为44%（P = 0.0003）。对于HLA匹配的同胞，TRM为20%对35%（P = 0.01），对于无关供者，为20%对65%（P = 0.01）。在多变量分析中，第7天的评分对TRM具有高度预测性（风险比1.9，P < 0.01），在调整移植年份（P < 0.00001）、无关供者与同胞供者（P = 0.001）、患者年龄（P = 0.01）和诊断（P = 0.01）后。这些结果在一个儿科单位的82例异基因BMT受者的独立组中得到验证，低风险患者的精算TRM为16%，高风险患者为46%（P = 0.002）。本研究表明，在BMT后第7天有可能识别出具有不同TRM风险的患者：高风险患者可能有资格参加旨在加强移植后并发症预防的项目。