Pre Transplant Values of C Reactive Protein (CRP) and Brain Natriuretic Peptide (BNP) as Predictors of Transplant Outcomes in Patients with Acute Myelogenous Leukemia or Myelodysplastic Syndromes (AML/MDS) Undergoing Allogeneic Stem Cell Transplantation (AlloSCT).

Abstract

BACKGROUND: Developing prognostic factors for allo SCT is important in deciding transplant approaches for older patients with AML/MDS. BNP levels and CRP levels have been shown to predict outcomes in patients with amyloidosis or cardiovascular diseases. We hypothesized that in patients with AML/MDS pretransplant levels of BNP and CRP would be associated with transplant outcomes.PATIENT & METHODS: All patients with AML/MDS undergoing allogeneic SCT from January 1 2006 until December 31 2006 had pre SCT levels of BNP and CRP drawn and included for analysis. Pretransplants levels of BNP and CRP were analyzed in quartiles and correlated with NCI toxicities, 1 year non relapse mortality (NRM) and overall survival (OS).RESULTS: Patient characteristics are summarized in table 1 and outcomes according to remission status are summarized in table 2. In brief, a total of 106 patients were identified, median age was 50 years, median time to allo SCT was 9 months, 50% of patients were in CR at the time of SCT. Patients IN CR were younger, had lower comorbidity scores, lower median pre SCT CRP and BNP levels and had a higher likelihood of receiving an ablative regimen than patients NOT IN CR. In patients IN CR low levels of CRP prior to SCT predicted for better 1 yr survival and lower NRM. In patients NOT IN CR, higher CRP and BNP levels were associated with a trend towards an increased risk of toxicity. Higher CRP levels were also associated with a trend towards worse OS and NRM rates.CONCLUSIONS: Pre SCT CRP and BNP levels are associated with allogeneic transplant outcomes in patients with AML/MDS and further study with larger patient numbers is warranted. The relationship of CRP levels and NRM suggests a potential role for IL6 in transplant associated toxicities.Patient CharacteristicsVariableCR @ SCTNo CR @ SCTpMedian Age, range48 (22–70)54 (21–69)0.005Time to SCT9 m (3–62)11 m (2–69)NS% 6/6 Sibling4732NS% 6/6 MUD3847NSOther Donor1521NSSeattle HCT Score 0–124%15%NSSeattle HCT Score 2–460%45%NSSeattle HCT Score >415%40%0.02% RIC36%55%.05CRP median0.311.1<0.001BNP median2974<0.001CRP nl range (<0.8 mg/dl) BNP nl range (0–100 pg/dl) NS= non significantOutcomesIN CR PRE SCT> Grade 3 ToxpOS @ 1 yearHR (p)NRM @ 1 yearHR (p)CRP≤ median8%72%0%CRP > median12%0.537%3.0 (0.09)52%ne (0.007)CRP≤ 1st qtl8%100%0%CRP > 1st qtl10%0.638%ne (0.03)41%ne (0.09)BNP≤ 1st qtl7%61%21%BNP > 1st qtl10%0.636%0.8 (0.7)47%0.5 (0.4)NOT IN CR PRE SCTCRP≤ median8%39%10%CRP > median25%0.150%1.1 (0.8)14%1.6 (0.6)CRP≤ 1st qtl7%71%0%CRP > 1st qtl19%0.339%0.5 (0.2)16%ne (0.1)BNP≤ 1st qtl0%58%8%BNP > 1st qtl20%0.0745%0.9 (0.9)12%0.8 (0.8)qtl=quartile; ne=not evaluable