Early predictors of transplant-related mortality (TRM) after allogeneic bone marrow transplants (BMT): Blood urea nitrogen (BUN) and bilirubin

A. Bacigalupo, R. Oneto, B. Bruno, M. Soracco, T. Lamparelli, F. Gualandi, D. Occhini, A. M. Raiola, N. Mordini, G. Berisso, S. Bregante, G. Dini, A. Lombardi, M. T. Van Lint, R. Brand

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Abstract

Transplant-related mortality (TRM) following allogeneic bone marrow transplantation (BMT) remains a major concern and early identification of patients at risk may be clinically relevant. In this study we describe a predictive score based on bilirubin and blood urea nitrogen (BUN) levels on day +7 after BMT. The patient population consisted of 309 consecutive patients who underwent BMT from sibling (n = 263) or unrelated donors (n = 46) for hematologic disorders between December 1990 and December 1996. Of 27 laboratory tests taken on day +7 after BMT, serum bilirubin (P = 0.02) and BUN (P = 0.007) were found to be independent predictors of TRM in multivariate analysis. The median levels of bilirubin (0.9 mg/dl) and of BUN (21 mg/dl) were then used as a cut-off and a score of 1 was given for values equal/greater than the median. There were 216 patients with scores 0-1 (low risk) on day +7 (bilirubin <0.9 and/or BUN <21) and 93 patients with score 2 (high risk) (bilirubin ≥ 0.9 and BUN ≥ 21): the latter had more grade III-IV acute graft-versus-host disease (P = 0.03), slower neutrophil (P = 0.02) and slower platelet engraftment (P = 0.002). The actuarial 5 year TRM is 22% for low risk vs 44% for high risk patients (P = 0.0003). For HLA-identical siblings TRM is 20% vs 35% (P = 0.01), for unrelated donors it is 20% vs 65% (P = 0.01). Day +7 score was highly predictive of TRM on multivariate analysis (hazard ratio 1.9, P <0.01), after adjustment for year of transplant (P <0.00001), unrelated vs sibling donors (P = 0.001), patient age (P = 0.01) and diagnosis (P = 0.01). These results were validated on an independent group of 82 allogeneic BMT recipients in a pediatric unit who showed an actuarial TRM of 16% for low risk vs 46% for high risk patients (P = 0.002). This study suggests that it may be possible to identify patients with different risks of TRM on day +7 after BMT: high risk patients could be eligible for programs designed to intensify prophylaxis of post-transplant complications.

Original languageEnglish
Pages (from-to)653-659
Number of pages7
JournalBone Marrow Transplantation
Volume24
Issue number6
Publication statusPublished - 1999

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Keywords

  • Bone marrow transplants
  • GVHD
  • Transplant mortality

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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