title: Early predictors of transplant-related mortality (TRM) after allogeneic bone marrow transplants (BMT): blood urea nitrogen (BUN) and bilirubin.
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.
authors.affiliation: Divisione Ematologia II Ospedale San Martino, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: R
authors.initials: R
authors.lastname: Oneto
authors.forename: B
authors.initials: B
authors.lastname: Bruno
authors.forename: M
authors.initials: M
authors.lastname: Soracco
authors.forename: T
authors.initials: T
authors.lastname: Lamparelli
authors.forename: F
authors.initials: F
authors.lastname: Gualandi
authors.forename: D
authors.initials: D
authors.lastname: Occhini
authors.forename: A
authors.initials: A
authors.lastname: Raiola
authors.forename: N
authors.initials: N
authors.lastname: Mordini
authors.forename: G
authors.initials: G
authors.lastname: Berisso
authors.forename: S
authors.initials: S
authors.lastname: Bregante
authors.forename: G
authors.initials: G
authors.lastname: Dini
authors.forename: A
authors.initials: A
authors.lastname: Lombardi
authors.forename: M V
authors.initials: MV
authors.lastname: Lint
authors.forename: R
authors.initials: R
authors.lastname: Brand
mesh_terms: D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood*; D001806:Blood Urea Nitrogen; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D014184:Transplantation, Homologous
chemical_list: D001663:Bilirubin