TY - JOUR
T1 - Baseline Renal Function and Albumin are Powerful Predictors for Allogeneic Transplantation-Related Mortality
AU - Shouval, Roni
AU - de Jong, Cornelis N.
AU - Fein, Joshua
AU - Broers, Annoek E.C.
AU - Danylesko, Ivetta
AU - Shimoni, Avichai
AU - Reurs, Marloes R.
AU - Baars, Adája E.
AU - van der Schaft, Niels
AU - Nagler, Arnon
AU - Cornelissen, Jan J.
N1 - Publisher Copyright:
© 2018 The American Society for Blood and Marrow Transplantation
PY - 2018/8
Y1 - 2018/8
N2 - Biomarkers measured in blood chemistry before allogeneic hematopoietic stem cell transplantation (HSCT) may reflect patients’ physiological status. We hypothesized that selected markers are predictive for nonrelapse mortality (NRM) following transplantation and could contribute to risk assessment. We investigated the value of pre-HSCT albumin, estimated glomerular filtration rate (eGFR), and alkaline phosphatase (AlkP) in predicting NRM. We retrospectively analyzed clinical and laboratory data from 1217 patients receiving a first HSCT in 2 European centers between 2003 and 2015. Transplantation indications and conditioning regimens were diverse. Patients had a median age of 55 years and hematopoietic cell transplantation comorbidity index (HCT-CI) scores of 0 (24%), 1 to 2 (39%), and ≥3 (37%). Cutoffs of eGFR <60 mL/min, albumin <3.5 g/dL, and AlkP >180 IU/L corresponded with 8.8%, 8.3%, and 6.5% of the patients, respectively. eGFR and albumin were associated with increased risk and higher cumulative incidence of day-100, 1-year, and 2-year NRM, both as continuous or categorized variables. A similar pattern was observed for AlkP, except for day-100 NRM. In multivariable analyses, eGFR and albumin were consistently among the top risk factors for early and late-term NRM, abrogating the role of age. Prediction models for day-100, 1-year, and 2-year NRM based only on HCT-CI resulted in c-statistics of.565,.575, and.577, respectively. Addition of both biomarkers increased c-statistics for day-100, 1-year, and 2-year NRM to.651,.633, and.624, respectively. Albumin and eGFR are prognostic biomarkers for NRM after HSCT and improve the discriminative power of the HCT-CI.
AB - Biomarkers measured in blood chemistry before allogeneic hematopoietic stem cell transplantation (HSCT) may reflect patients’ physiological status. We hypothesized that selected markers are predictive for nonrelapse mortality (NRM) following transplantation and could contribute to risk assessment. We investigated the value of pre-HSCT albumin, estimated glomerular filtration rate (eGFR), and alkaline phosphatase (AlkP) in predicting NRM. We retrospectively analyzed clinical and laboratory data from 1217 patients receiving a first HSCT in 2 European centers between 2003 and 2015. Transplantation indications and conditioning regimens were diverse. Patients had a median age of 55 years and hematopoietic cell transplantation comorbidity index (HCT-CI) scores of 0 (24%), 1 to 2 (39%), and ≥3 (37%). Cutoffs of eGFR <60 mL/min, albumin <3.5 g/dL, and AlkP >180 IU/L corresponded with 8.8%, 8.3%, and 6.5% of the patients, respectively. eGFR and albumin were associated with increased risk and higher cumulative incidence of day-100, 1-year, and 2-year NRM, both as continuous or categorized variables. A similar pattern was observed for AlkP, except for day-100 NRM. In multivariable analyses, eGFR and albumin were consistently among the top risk factors for early and late-term NRM, abrogating the role of age. Prediction models for day-100, 1-year, and 2-year NRM based only on HCT-CI resulted in c-statistics of.565,.575, and.577, respectively. Addition of both biomarkers increased c-statistics for day-100, 1-year, and 2-year NRM to.651,.633, and.624, respectively. Albumin and eGFR are prognostic biomarkers for NRM after HSCT and improve the discriminative power of the HCT-CI.
KW - Albumin
KW - Allogeneic hematopoietic stem cell transplantation
KW - Comorbidities
KW - Nonrelapse mortality
KW - Renal function
UR - http://www.scopus.com/inward/record.url?scp=85047521896&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2018.05.005
DO - 10.1016/j.bbmt.2018.05.005
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C2 - 29753163
AN - SCOPUS:85047521896
SN - 1083-8791
VL - 24
SP - 1685
EP - 1691
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 8
ER -