A revised day |[plus]|7 predictive score for transplant-related mortality: serum cholinesterase, total protein, blood urea nitrogen, |[gamma]| glutamyl transferase, donor type and cell dose

doi:doi:10.1038/sj.bmt.1704085

Bone Marrow Transplantation (2003) 32, 205–211. doi:10.1038/sj.bmt.1704085

A revised day +7 predictive score for transplant-related mortality: serum cholinesterase, total protein, blood urea nitrogen, glutamyl transferase, donor type and cell dose

M P Sormani², R Oneto¹, B Bruno¹, M Fiorone¹, T Lamparelli¹, F Gualandi¹, A M Raiola¹, A Dominietto¹, M T Van Lint¹, F Frassoni¹, P Bruzzi² and A Bacigalupo¹

¹Divisione Ematologia II Ospedale San Martino, Genova, Italy
²Unita' Epidemiologia Clinica, Istituto Scientifio Tumori, Genova

Correspondence: Dr A Bacigalupo, Divisione Ematologia 2 (PAD 5/II), Ospedale San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy

Received 27 June 2002; Accepted 22 January 2003.

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Abstract

We have previously described a scoring system for patients undergoing hemopoietic stem cell transplantation (HSCT) based on day +7 blood urea nitrogen (BUN) and serum bilirubin levels. We have revised that scoring system using a formal multivariate approach based on a training phase (305 patients) and a validation phase (217 patients). Day +7 BUN, serum cholinesterase (CHE), total proteins (TP), gamma glutamyl transferase (GT), donor type and cell dose at transplant were included in the new score. The score distribution identified three groups of patients in the training set (<25, 25-75, >75 percentile of the score) which were classified as low, intermediate and high risk. Their actuarial risk of transplant-related mortality (TRM) at 6 years was, respectively, 12, 38 and 60%. In the validation set the 6 year actuarial TRM was, respectively, 15, 40 and 69%. High risk patients had more graft-versus-host disease (GvHD) (P<0.0001) and lower platelet counts (P<0.0001). This study confirms that GvHD and TRM can be predicted on day +7 after HSCT: pre-emptive GvHD therapy may be one option for high-risk patients and is being tested in a prospective randomized trial. The score for single patients can be calculated on the web site http://213.26.110.20/lrm/day_seven_score.html.