Utility of Procalcitonin in the Engraftment Phase of Hematopoietic Stem Cell Transplantation in Children

Abstract

Aim:In hematopoietic stem cell transplantation (HSCT), the phase of engraftment which can be described as an “immunogenic storm”, is also vulnerable to infections and it has been always very hard to discriminate the cause of fever in this special period of HSCT. In this study, we aim to determine if procalcitonin (PCT) could be used to define the cause of fever in the engraftment phase of HSCT.Materials and Methods:This study involves 81 patients who consecutively underwent allogeneic HSCT between October 2017-June 2020 in our pediatric HSCT unit. The patients were divided into two groups due to the origin of the fever during engraftment as infectious fever group (n=42) and the non-infectious fever group (n=39).Results:The median duration of fever for all groups was 4 days (1-11 days) and it was significantly lower in the non-infectious fever group compared to the infectious fever group (3 vs. 4 respectively p=0.001). The median PCT levels was 0.6 ng/mL (0.04-83) for all groups and it was significantly higher in the infectious fever group compared to non-infectious (1.4 vs. 0.3 p<0.001). According to ROC analysis, the cut-off PCT level of 0.515 ng/mL or more had an AUC of 0.817 and may predict the infectious fever with a sensitivity of 81% and a specificity of 76.9%.Conclusion:We observed that PCT may be used to discriminate infectious fever from non-infectious fever at the engraftment phase of HSCT and PCT could be a useful marker for antibiotic treatment strategy.

Keywords

• engraftment
• hematopoetic stem cell transplantation
• procalcitonin