An early increase in serum levels of C-reactive protein is an independent risk factor for the occurrence of major complications and 100-day transplant-related mortality after allogeneic bone marrow transplantation

Abstract

Summary:We monitored levels of C-reactive protein (CRP) in 96 consecutive adult allogeneic BMT patients (age 15-50 years) transplanted in our unit. Major transplantrelated complications (MTC) occurred in 32% of cases and included: hepatic veno-occlusive disease, pneumonitis, severe endothelial leakage syndrome and >II acute GVHD. Transplant-related mortality (TRM) before day 100 post-BMT was 13.5%. Variables included in a stepwise logistic regression model were: gender, age, disease category, donor type, T cell depletion, TBI, use of growth factors, bacteremia, mean CRP-levels >50 mg/l between days 0 and 5 (CRP day 0-5) and >100 mg/l between days 6 and 10 (CRP day 6-10) post-BMT. Only high CRP-levels (for MTC and TRM) (P < 0.001) and donor-type (for TRM) (P ‫؍‬ 0.02) were independent risk factors. The estimated probability for MTC was 73% (CRP day 6-10 >100 mg/l) vs 17% (CRP day 6-10 <100 mg/l). Using the same cut-off levels, the probabilities for TRM were 36.5% vs 1% in the identical sibling donor situation and 88% vs 12.5% in other donor-type transplants. We conclude that the degree of systemic inflammation, as reflected by CRP-levels, during the first 5-10 days after BMT identifies patients at risk of MTC and TRM. Our data may be useful in selecting patients for clinical trials involving pre-emptive antiinflammatory treatment. Bone Marrow Transplantation (2002) 30, 441-446. doi:10.1038/sj.bmt.1703672 Keywords: C-reactive protein; severe complications; transplant-related mortality; allogeneic BMT Despite improvements in supportive care, the practice of allogeneic BMT remains limited by its toxicity. Overall

Patterns of C-reactive protein release following allogeneic stem cell transplantation are correlated with leukemic relapse

“…28 However, bacteremia is not the main trigger for early CRP release in patients undergoing SCT because it occurred in similar patients with post transplant complications. These results are consistent with the reports 6,7 showing that the patients with high CRP levels proved to be useful for identifying those patients who develop acute and/or chronic GvHD as well as other complications. Our results strongly suggest that the early rise in CRP is a surrogate for acute and/or chronic GvHD which themselves are powerful predictors of relapse.…”

“…5 In marrow transplant recipients, the CRP levels have been reported to increase in association with the early complications including acute GvHD, hepatic venoocclusive disease (VOD) and pneumonitis. 6,7 This study examined the relationship between the post-SCT CRP levels and leukemic relapse. The mean CRP levels throughout the early post-SCT episode were found to be significantly lower in the relapsing patients than in those who did not experience relapse.…”

Are predictive factors clinically useful in bone marrow transplantation?

“…73 One group reported that an increase in serum levels of C-reactive protein is a risk factor for the occurrence of treatment-related complications after allo-BMT. 74 Finally, two studies suggest the possibility of psychosocial factors influencing outcome after stem cell transplantation. A study of 193 patients found that patients who were depressed post BMT (auto or allo) had a three-fold risk of dying than did nondepressed patients.…”

Measurement of C-reactive protein in adults with febrile neutropenia after hematopoietic cell transplantation

“…Manian et al 6 obtained similar results in adult neutropenic patients. Schots et al 7,8 described that in recipients of an allogeneic bone marrow transplantation, a CRP value higher than 10 mg/dl between days 6 and 10 after the progenitor cell infusion was an independent risk factor for the occurrence of major transplant-related events (infections, hepatic veno-occlusive disease, pneumonitis, severe endothelial leakage syndrome and acute graft-versus-host disease) and also for 100-day transplant-related mortality. However, the experience of Schots et al 7,8 was that CRP measurement could neither identify the patients with fever secondary to a bacterial infection nor the patients with a fatal outcome of infectious origin during the neutropenic period.…”