The prognostic value of serum C-reactive protein, ferritin, and albumin prior to allogeneic transplantation for acute myeloid leukemia and myelodysplastic syndromes
Andrew S. Artz,
Brent Logan,
Xiaochun Zhu,
Gorgun Akpek,
Rodrigo Martino Bufarull,
Vikas Gupta,
Hillard M. Lazarus,
Mark Litzow,
Alison Loren,
Navneet S. Majhail,
Richard T. Maziarz,
Philip McCarthy,
Uday Popat,
Wael Saber,
Stephen Spellman,
Olle Ringden,
Amittha Wickrema,
Marcelo C. Pasquini,
Kenneth R. Cooke
Affiliations
Andrew S. Artz
Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA
Brent Logan
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
Xiaochun Zhu
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA
Gorgun Akpek
Stem Cell Transplantation and Cellular Therapy Program, Banner MD Anderson Cancer Center, Gilbert, AZ, USA
Rodrigo Martino Bufarull
Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
Vikas Gupta
Blood and Marrow Transplant Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Hillard M. Lazarus
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA
Mark Litzow
Division of Hematology and Transplant Center, Mayo Clinic Rochester, Minneapolis, MN, USA
Alison Loren
Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Navneet S. Majhail
Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, OH, USA
Richard T. Maziarz
Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
Philip McCarthy
Blood & Marrow Transplant Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
Uday Popat
MD Anderson Cancer Center, Houston, TX, USA
Wael Saber
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA
Stephen Spellman
CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN, USA
Olle Ringden
Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden;Centre for Allogeneic Stem Cell Transplantation, Stockholm, Sweden
Amittha Wickrema
Section of Hematology/Oncology, University of Chicago School of Medicine, IL, USA
Marcelo C. Pasquini
CIBMTR, (Center for International Blood and Marrow Transplant Research), Department of Medicine, Milwaukee, WI, USA
Kenneth R. Cooke
Pediatric Blood and Marrow Transplant Program, The Sidney Kimmel Cancer Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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
