TY - JOUR
T1 - Early predictors of transplant-related mortality (TRM) after allogeneic bone marrow transplants (BMT)
T2 - Blood urea nitrogen (BUN) and bilirubin
AU - Bacigalupo, A.
AU - Oneto, R.
AU - Bruno, B.
AU - Soracco, M.
AU - Lamparelli, T.
AU - Gualandi, F.
AU - Occhini, D.
AU - Raiola, A. M.
AU - Mordini, N.
AU - Berisso, G.
AU - Bregante, S.
AU - Dini, G.
AU - Lombardi, A.
AU - Van Lint, M. T.
AU - Brand, R.
PY - 1999
Y1 - 1999
N2 - 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.
AB - 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.
KW - Bone marrow transplants
KW - GVHD
KW - Transplant mortality
UR - http://www.scopus.com/inward/record.url?scp=0032855629&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032855629&partnerID=8YFLogxK
M3 - Article
C2 - 10490732
AN - SCOPUS:0032855629
VL - 24
SP - 653
EP - 659
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
SN - 0268-3369
IS - 6
ER -