Artz Andrew S, Logan Brent, Zhu Xiaochun, Akpek Gorgun, Bufarull Rodrigo Martino, Gupta Vikas, Lazarus Hillard M, Litzow Mark, Loren Alison, Majhail Navneet S, Maziarz Richard T, McCarthy Philip, Popat Uday, Saber Wael, Spellman Stephen, Ringden Olle, Wickrema Amittha, Pasquini Marcelo C, Cooke Kenneth R
Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA.
Haematologica. 2016 Nov;101(11):1426-1433. doi: 10.3324/haematol.2016.145847. Epub 2016 Aug 4.
We sought to confirm the prognostic importance of simple clinically available biomarkers of C-reactive protein, serum albumin, and ferritin prior to allogeneic hematopoietic cell transplantation. The study population consisted of 784 adults with acute myeloid leukemia in remission or myelodysplastic syndromes undergoing unrelated donor transplant reported to the Center for International Blood and Marrow Transplant Research. C-reactive protein and ferritin were centrally quantified by ELISA from cryopreserved plasma whereas each center provided pre-transplant albumin. In multivariate analysis, transplant-related mortality was associated with the pre-specified thresholds of C-reactive protein more than 10 mg/L (P=0.008) and albumin less than 3.5 g/dL (P=0.01) but not ferritin more than 2500 ng/mL. Only low albumin independently influenced overall mortality. Optimal thresholds affecting transplant-related mortality were defined as: C-reactive protein more than 3.67 mg/L, log(ferritin), and albumin less than 3.4 g/dL. A 3-level biomarker risk group based on these values separated risks of transplant-related mortality: low risk (reference), intermediate (HR=1.66, P=0.015), and high risk (HR=2.7, P<0.001). One-year survival was 74%, 67% and 56% for low-, intermediate- and high-risk groups. Routinely available pre-transplant biomarkers independently risk-stratify for transplant-related mortality and survival.
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