The prognostic value of serum C-reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes.
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.
Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA aartz@medicine.bsd.uchicago.edu.
Andrew S
AS
Artz
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
Brent
B
Logan
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA.
Xiaochun
X
Zhu
Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, AZ, USA.
Gorgun
G
Akpek
Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
Rodrigo Martino
RM
Bufarull
Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
Vikas
V
Gupta
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
Hillard M
HM
Lazarus
Division of Hematology and Transplant Center, Mayo Clinic Rochester, Minneapolis, MN, USA.
Mark
M
Litzow
Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Alison
A
Loren
Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, OH, USA.
Navneet S
NS
Majhail
Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
Richard T
RT
Maziarz
Blood & Marrow Transplant Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.
Philip
P
McCarthy
MD Anderson Cancer Center, Houston, TX, USA.
Uday
U
Popat
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA.
Wael
W
Saber
CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.
Stephen
S
Spellman
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.|Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden.
Olle
O
Ringden
Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA.
Amittha
A
Wickrema
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA.
Marcelo C
MC
Pasquini
Kenneth R
KR
Cooke
D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D005293:Ferritins / Q000097:blood*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult
D014408:Biomarkers, Tumor; D012709:Serum Albumin; D002097:C-Reactive Protein; D005293:Ferritins
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