title: Preengraftment serum C-reactive protein (CRP) value may predict acute graft-versus-host disease and nonrelapse mortality after allogeneic hematopoietic stem cell transplantation.
abstract: In a mouse model, inflammatory cytokines play a primary role in the development of acute graft-versus-host disease (aGVHD). Here, we retrospectively evaluated whether the preengraftment C-reactive protein (CRP) value, which is used as a surrogate marker of inflammation, could predict posttransplant complications including GVHD. Two hundred twenty-four adult patients (median age, 47 years; range: 18-68 years) underwent conventional stem cell transplantation (CST, n = 105) or reduced-intensity stem cell transplantation (RIST, n = 119). Patients were categorized according to the maximum CRP value during neutropenia: the "low-CRP" group (CRP < 15 mg/dL, n = 157) and the "high-CRP" group (CRP >or= 15 mg/dL, n = 67). The incidence of documented infections during neutropenia was higher in the high-CRP group (34% versus 17%, P = .004). When patients with proven infections were excluded, the CRP value was significantly lower after RIST than after CST (P = .017) or after related than after unrelated transplantation (P < .001). A multivariate analysis showed that male sex, unrelated donor, and HLA-mismatched donor were associated with high CRP values. The high-CRP group developed significantly more grade II-IV aGVHD (P = .01) and nonrelapse mortality (NRM) (P < .001), but less relapse (P = .02). The present findings suggest that the CRP value may reflect the net degree of tissue damage because of the conditioning regimen, infection, and allogeneic immune reactions, all of which lead to subsequent aGVHD and NRM.
authors.affiliation: Department of Hematology and Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Fuji
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamasaki
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Morita-Hoshi
authors.forename: Fusako
authors.initials: F
authors.lastname: Ohara-Waki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Heike
authors.forename: Kensei
authors.initials: K
authors.lastname: Tobinai
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D002097:C-Reactive Protein