title: Hyperbilirubinemia in the early phase after allogeneic HSCT: prognostic significance of the alkaline phosphatase/total bilirubin ratio.
abstract: Hyperbilirubinemia in the early phase after allogeneic hematopoietic SCT (HSCT) is due to various causes. One of the most important causes of hyperbilirubinemia is veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS). However, the prognosis of patients who are clinically diagnosed as SOS varies. We retrospectively evaluated 82 patients who underwent their first allogeneic HSCT. GVHD prophylaxis was a combination of short-term MTX and CsA (n=77) or tacrolimus (n=5). Thirty-three patients developed hyperbilirubinemia, with a bilirubin level of at least 2 mg/dL, within 20 days after HSCT. Of these patients, 24 were diagnosed as VOD/SOS using the modified Seattle criteria. Twenty-six recovered to a bilirubin level of <2 mg/dL. We focused on the serum alkaline phosphatase/total bilirubin ratio (ALP/TB) at the onset of hyperbilirubinemia and found that it significantly predicted the recovery from hyperbilirubinemia. OS was significantly higher in patients with a lower ALP/TB ratio (P=0.00056). In addition, a lower ALP/TB ratio was associated with better survival even in patients who were clinically diagnosed as SOS (P<0.001). The ALP/TB ratio at the onset of hyperbilirubinemia may be a useful predictor for the prognosis of hyperbilirubinemia and SOS early after HSCT.
authors: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama 330-8503, Japan.
authors: M
authors: M
authors: Ashizawa
authors: K
authors: K
authors: Oshima
authors: H
authors: H
authors: Wada
authors: Y
authors: Y
authors: Ishihara
authors: K
authors: K
authors: Kawamura
authors: K
authors: K
authors: Sakamoto
authors: M
authors: M
authors: Sato
authors: K
authors: K
authors: Terasako
authors: T
authors: T
authors: Machishima
authors: S
authors: S
authors: Kimura
authors: M
authors: M
authors: Kikuchi
authors: H
authors: H
authors: Nakasone
authors: S
authors: S
authors: Okuda
authors: S
authors: S
authors: Kako
authors: J
authors: J
authors: Kanda
authors: R
authors: R
authors: Yamazaki
authors: A
authors: A
authors: Tanihara
authors: J
authors: J
authors: Nishida
authors: Y
authors: Y
authors: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000469:Alkaline Phosphatase / Q000097:blood*; D001663:Bilirubin / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood / Q000209:etiology*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000469:Alkaline Phosphatase; D001663:Bilirubin