Min C-K, Kim S Y, Eom K S, Kim Y J, Kim H J, Lee S, Kim D W, Lee J W, Min W S, Kim C C
Catholic Hemopoietic Stem Cell Transplantation Center, The Catholic University of Korea, Seoul, Korea.
Bone Marrow Transplant. 2006 Mar;37(5):493-8. doi: 10.1038/sj.bmt.1705276.
The C-reactive protein (CRP) is an acute-phase protein produced by hepatocytes, and is a reliable marker of systemic inflammation, which is relevant to the release of the proinflammatory cytokines. The value of monitoring the CRP levels after stem cell transplantation (SCT) can identify patients at risk of treatment-related complications and mortality. Inflammatory cytokines facilitate donor T-cell activation via antigen presenting cells immediately after SCT. This study examined the relationship between the post-SCT CRP levels and a leukemic relapse. Fifty-four consecutively transplanted patients who relapsed after the allogeneic SCT were compared with nonrelapsing patients. The serum CRP levels were measured on day 0 and every 7 days thereafter until 4 weeks after the SCT. The mean CRP levels throughout the early post-SCT episode were significantly lower in the relapsing patients than in those who did not experience relapse (mean+/-s.e.: 26.8 +/- 6.3 vs 65.3 +/- 9.4 for first week, P = 0.001; 23.9 +/- 3.8 vs 44.6 +/- 6.6 for second week, P = 0.008). Univariate analysis showed that the CRP level on the first and second week, and graft-versus-host disease were significantly associated with a relapse. Multivariate analysis showed that the CRP level on the first week was the strongest independent variable predicting the risk of a relapse after SCT (P = 0.04). These results indicate that the serum CRP levels early after allogeneic SCT might display the graft-versus-leukemia (GvL) effect. CRP is a surrogate of the proinflammatory cytokine release that was not measured in this study. The GvL effect appears to be efficiently strengthened by the high CRP levels that may be reflecting T-cell activation.
C反应蛋白（CRP）是一种由肝细胞产生的急性期蛋白，是全身炎症反应的可靠标志物，与促炎细胞因子的释放有关。监测干细胞移植（SCT）后CRP水平的价值在于识别有治疗相关并发症和死亡风险的患者。SCT后，炎症细胞因子可通过抗原呈递细胞促进供体T细胞活化。本研究探讨了SCT后CRP水平与白血病复发之间的关系。将54例异基因SCT后复发的连续移植患者与未复发患者进行比较。在第0天及之后每7天测量血清CRP水平，直至SCT后4周。在整个SCT后早期阶段，复发患者的平均CRP水平显著低于未复发患者（第一周：平均值±标准误为26.8±6.3 vs 65.3±9.4，P = 0.001；第二周：23.9±3.8 vs 44.6±6.6，P = 0.008）。单因素分析显示，第一周和第二周的CRP水平以及移植物抗宿主病与复发显著相关。多因素分析显示，第一周的CRP水平是预测SCT后复发风险的最强独立变量（P = 0.04）。这些结果表明，异基因SCT后早期血清CRP水平可能显示移植物抗白血病（GvL）效应。CRP是本研究中未测量的促炎细胞因子释放的替代指标。高CRP水平可能反映T细胞活化，似乎可有效增强GvL效应。
