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Post-Transplant Complications

An early increase in serum levels of C-reactive protein is an independent risk factor for the occurrence of major complications and 100-day transplant-related mortality after allogeneic bone marrow transplantation

Bone Marrow Transplantation volume 30, pages 441–446 (2002)Cite this article

Abstract

We monitored levels of C-reactive protein (CRP) in 96 consecutive adult allogeneic BMT patients (age 15–50 years) transplanted in our unit. Major transplant-related complications (MTC) occurred in 32% of cases and included: hepatic veno-occlusive disease, pneumonitis, severe endothelial leakage syndrome and >II acute GVHD. Transplant-related mortality (TRM) before day 100 post-BMT was 13.5%. Variables included in a stepwise logistic regression model were: gender, age, disease category, donor type, T cell depletion, TBI, use of growth factors, bacteremia, mean CRP-levels >50 mg/l between days 0 and 5 (CRP day 0–5) and >100 mg/l between days 6 and 10 (CRP day 6–10) post-BMT. Only high CRP-levels (for MTC and TRM) (P < 0.001) and donor-type (for TRM) (P = 0.02) were independent risk factors. The estimated probability for MTC was 73% (CRP day 6–10 >100 mg/l) vs 17% (CRP day 6–10 <100 mg/l). Using the same cut-off levels, the probabilities for TRM were 36.5% vs 1% in the identical sibling donor situation and 88% vs 12.5% in other donor-type transplants. We conclude that the degree of systemic inflammation, as reflected by CRP-levels, during the first 5–10 days after BMT identifies patients at risk of MTC and TRM. Our data may be useful in selecting patients for clinical trials involving pre-emptive anti-inflammatory treatment.

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Acknowledgements

We thank Mrs A Willekens and her nursing staff from the BMT-Unit for the excellent care of our patients. This work was supported by grant from the scientific Fund W Gepts AZ-VUB.

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Authors and Affiliations

  1. BMT Unit, Academisch Ziekenhuis-Vrije Universiteit Brussel, Brussels, Belgium

    R Schots, I Van Riet, F Trullemans, M De Waele & B Van Camp

  2. Centre de Greffe de Moelle Osseuse, Tunis, Tunisia

    T Ben Othman

  3. Department of Medical Statistics, Academisch Ziekenhuis-Vrije Universiteit Brussel, Brussels, Belgium

    L Kaufman

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Schots, R., Van Riet, I., Ben Othman, T. et al. An early increase in serum levels of C-reactive protein is an independent risk factor for the occurrence of major complications and 100-day transplant-related mortality after allogeneic bone marrow transplantation. Bone Marrow Transplant 30, 441–446 (2002). https://doi.org/10.1038/sj.bmt.1703672

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