Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Mini Review
  • Published:

Are predictive factors clinically useful in bone marrow transplantation?

Bone Marrow Transplantation volume 32, pages 853–861 (2003)Cite this article

Summary:

Variables that accurately predict the clinical outcome of any procedure, including bone marrow transplantation (BMT), are of paramount importance when assessing the risks and benefits of the procedure. This review of the world's literature of variables affecting overall outcome after myeloablative BMT critically appraises the value of many bone marrow transplant dogmas. There is a relative paucity of data supporting many commonly used transplant practices, including having an upper age limit for eligibility criteria, and absolute requirements for cardiac and pulmonary function pre transplant. In contrast, recently published literature suggests that several parameters occurring soon after a BMT has been performed may accurately predict transplant outcome. Ultimately, given the rapidly evolving nature of BMT, renewed clinical research of variables predictive of transplant outcome is needed.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Bortin MM, Gale RP, Humphrey EM et al. Bone Marrow transplantation for acute myelogenous leukemia: factors associated with early mortality. JAMA 1983; 249: 1166–1175.

    Article  CAS  PubMed  Google Scholar 

  2. Dinsmore R, Kirkpatrick D, Flomenberg N et al. Allogeneic bone marrow transplantation for patients with acute nonlymphocytic leukemia. Blood 1984; 63: 649–656.

    CAS  PubMed  Google Scholar 

  3. McGlave PB, Haake RJ, Boström BC et al. Allogeneic bone marrow transplantation for acute nonlymphocytic leukemia in first remission. Blood 1988; 72: 1512–1517.

    CAS  PubMed  Google Scholar 

  4. Copelan EA, Biggs JC, Thompson JM et al. Treatment for acute myelocytic leukemia with allogeneic bone marrow transplantation following preparation with BuCy2. Blood 1991; 78: 838–843.

    CAS  PubMed  Google Scholar 

  5. Snyder DS, Chao NJ, Amylon MD et al. Fractionated total body irradiation and high-dose etoposide as a preparatory regimen for bone marrow transplantation for 99 patients with acute leukemia in first complete remission. Blood 1993; 82: 2920–2928.

    CAS  PubMed  Google Scholar 

  6. Keating S, Suciu S, deWitte T et al. Prognostic factors of patients with acute myeloid leukemia (AML) allografted in first complete remission: an analysis of the EROTC-EIMEMA AML 8A trial. Bone Marrow Transplant 1996; 17: 993–1001.

    CAS  PubMed  Google Scholar 

  7. Barrett AJ, Horowitz MM, Gale RP et al. Marrow transplantation for acute lymphoblastic leukemia: factors affecting relapse and survival. Blood 1989; 74: 862–871.

    CAS  PubMed  Google Scholar 

  8. Sutton L, Kuentz M, Cordonnier C et al. Allogeneic bone marrow transplantation for adult acute lymphoblastic leukemia in first complete remission: factors predictive of transplant-related mortality and influence of total body irradiation modalities. Bone Marrow Transplant 1993; 12: 583–589.

    CAS  PubMed  Google Scholar 

  9. Frassoni F, Labopin M, Gluckman E et al. Results of allogeneic bone marrow transplantation for acute lymphoblastic leukemia have improved in Europe with time: a report of the acute leukemia working party of the European group for blood and marrow transplantation (EBMT). Bone Marrow Transplant 1996; 17: 13–18.

    CAS  PubMed  Google Scholar 

  10. Thomas ED, Clift RA, Fefer A et al. Marrow transplantation for the treatment of chronic myelogenous leukemia. Ann Intern Med 1986; 104: 155–163.

    Article  CAS  PubMed  Google Scholar 

  11. Goldman JM, Gale RP, Horowitz MM et al. Bone marrow transplantation for chronic myelogenous leukemia in chronic phase. Ann Intern Med 1988; 108: 806–814.

    Article  CAS  PubMed  Google Scholar 

  12. Gratwhol A, Hermans J, Niederwieser D et al. Bone marrow transplantation for chronic myelogenous leukemia: long-term results. Bone Marrow Transplant 1993; 12: 509–516.

    Google Scholar 

  13. Bacigalupo A, Gualandi F, Van Lint MT et al. Multivariate analysis of risk factors for survival and relapse in chronic granulocytic leukemia following allogeneic marrow transplantation: impact of disease related variables (Sokal score). Bone Marrow Transplant 1993; 12: 443–448.

    CAS  PubMed  Google Scholar 

  14. Gratwohl A, Hermans J, Boldman JM et al. Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Lancet 1998; 352: 1087–1092.

    Article  CAS  PubMed  Google Scholar 

  15. Bär BMAM, DeWitte T, Schattenberg A et al. Favourable outcome of patients older than 40 years of age after transplantation with marrow grafts depleted of lymphocytes by counterflow centrifugation. Br J Haematol 1990; 74: 53–60.

    Article  PubMed  Google Scholar 

  16. Ringdén O, Horowitz MM, Gale RP et al. Outcome after allogeneic bone marrow transplant for leukemia in older adults. JAMA 1993; 270: 57–60.

    Article  PubMed  Google Scholar 

  17. Rapoport AP, DiPersio JF, Martin BA et al. Patients >age 40 years undergoing autologous or allogeneic BMT have regimen-related mortality rates and event-free survivals comparable to patients <age 40 years. Bone Marrow Transplant 1995; 15: 523–530.

    CAS  PubMed  Google Scholar 

  18. Cahn J-Y, Labopin M, Schattenberg A et al. Allogeneic bone marrow transplantation for acute leukemia in patients over the age of 40 years. Leukemia 1997; 11: 416–419.

    Article  CAS  PubMed  Google Scholar 

  19. Du W, Dansey R, Abella EM et al. Successful allogeneic bone marrow transplantation in selected patients over 50 years of age: a single institution's experience. Bone Marrow Transplant 1998; 21: 1043–1047.

    Article  CAS  PubMed  Google Scholar 

  20. Ringdén O, Remberger M, Mattsson J et al. Transplantation with unrelated bone marrow in leukaemic patients above 40 years of age. Bone Marrow Transplant 1998; 21: 43–49.

    Article  PubMed  Google Scholar 

  21. Sweettenham JR, Pearce R, Philip T et al. High-dose therapy and autologous bone marrow transplantation for intermediate and high grade non-Hodgkin's lymphoma in patients aged 55 years and over: results from the European group for bone marrow transplantation. Bone Marrow Transplant 1994; 14: 981–987.

    Google Scholar 

  22. Cahn JY, Laboprin M, Mandelli F et al. Autologous bone marrow transplantation for first remission acute myeloblastic leukemia in patients older than 52 years: a retrospective analysis of the European bone marrow transplant group. Blood 1995; 85: 575–579.

    CAS  PubMed  Google Scholar 

  23. Miller CB, Piantadosi S, Vogelsang GB et al. Impact of age on outcome of patients with cancer undergoing autologous bone marrow transplant. J Clin Oncol 1996; 14: 1327–1332.

    Article  CAS  PubMed  Google Scholar 

  24. Kusnierz-Glaz Cr, Schlegel PG, Wong RM et al. Influence of age on the outcome of 500 autologous bone marrow transplant procedures for hematologic malignancies. J Clin Oncol 1997; 15: 18–25.

    Article  CAS  PubMed  Google Scholar 

  25. Copelan E, Bolwell B, Harris R et al. Analysis of age as a predictor of survival following allogeneic and autologous marrow transplantation. Proc Am Soc Clin Oncol 1996; 15: 84 (abstract).

    Google Scholar 

  26. Lazarus H, Horowitz M, Nugent M . Outcome of autotransplants in older adults. Proc Am Soc Clin Oncol 1996; 15: 338 (abstract).

    Google Scholar 

  27. Bross DS, Tutschka PJ, Farmer ER et al. Predictive factors for acute graft-versus-host disease in patients transplanted with HLA-identical bone marrow. Blood 1984; 63: 1265–1270.

    CAS  PubMed  Google Scholar 

  28. Gale RP, Bortin MM, van Bekkum DW et al. Risk factors for acute graft-versus-host disease. Br J Haematol. 1987; 67: 397–406.

    Article  CAS  PubMed  Google Scholar 

  29. Weisdorf D, Hakke R, Blazar B et al. Risk factors for acute graft-versus-host disease in histocompatible donor bone marrow transplantation. Transplantation 1991; 51: 1197–1203.

    Article  CAS  PubMed  Google Scholar 

  30. Nash RA, Pepe SM, Storb R et al. Acute graft-versus-host disease: analysis of risk factors after allogeneic bone marrow transplantation and prophylaxis with cyclosporine and methotrexate. Blood 1992; 80: 1838–1845.

    CAS  PubMed  Google Scholar 

  31. Hägglund H, Boström L, Remberger M et al. Risk factors for acute graft-versus-host disease in 291 consecutive HLA-identical bone marrow transplantation recipients. Bone Marrow Transplant 1995; 16: 747–753.

    PubMed  Google Scholar 

  32. Storb R, Prentice RL, Sullivan KM et al. Predictive factors in chronic graft-versus-host disease in patients with aplastic anemia treated by marrow transplantation from HLA-identical Siblings. Ann Intern Med 1983; 98: 461–466.

    Article  CAS  PubMed  Google Scholar 

  33. Atkinson K, Horowitz MM, Gale RP et al. Risk factors for chronic graft-versus-host disease after HLA-identical sibling bone marrow transplantation. Blood 1990; 75: 2459–2464.

    CAS  PubMed  Google Scholar 

  34. Ochs LA, Miller WJ, Filipovish AH et al. Predictive factors for chronic graft-versus-host disease after histocompatible sibling donor bone marrow transplantation. Bone Marrow Transplant 1994; 13: 455–460.

    CAS  PubMed  Google Scholar 

  35. Carlens S, Ringdén O, Remberger M et al. Risk factors for chronic graft-versus-host disease after bone marrow transplantation: a retrospective single centre analysis. Bone Marrow Transplant 1998; 22: 755–761.

    Article  CAS  PubMed  Google Scholar 

  36. Bensinger WI, Martin PJ, Storer B et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers. N Engl J Med 2001; 344: 175–181.

    Article  CAS  PubMed  Google Scholar 

  37. Powles R, Mehta J, Kulkarni S et al. Allogeneic blood and bone-marrow stem-cell transplantation in haematological malignant diseases: a randomised trial. Lancet 2000; 355: 1231–1237.

    CAS  PubMed  Google Scholar 

  38. Schmitz N, Bacigalupo A, Hasenclever D et al. Allogeneic bone marrow transplantation vs filgrastim-mobilised peripheral blood progenitor cell transplantation in patients with early leukaemia: first results of a randomised multicentre trial of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1998; 21: 995–1003.

    Article  CAS  PubMed  Google Scholar 

  39. Blaise D, Kuentz M, Fortanier C et al. Randomized trial of bone marrow versus lenograstim-primed blood cell allogeneic transplantation in patients with early-stage leukemia: a report from the Société Francaise de Greffe de Moelle. J Clin Oncol 2000; 18: 537–546.

    Article  CAS  PubMed  Google Scholar 

  40. Levine JE, Wiley J, Kletzel M et al. Cytokine-mobilized allogeneic peripheral blood stem cell transplants in children result in rapid engraftment and a high incidence of chronic GVHD. Bone Marrow Transplant 2000; 25: 13–18.

    Article  CAS  PubMed  Google Scholar 

  41. Solano C, Martinez C, Brunet S et al. Chronic graft-versus-host disease after allogeneic peripheral blood progenitor cell or bone marrow transplantation from matched related donors. A case–control study. Bone Marrow Transplant 1998; 22: 1129–1135.

    Article  CAS  PubMed  Google Scholar 

  42. Brown RA, Adkins D, Khoury H et al. Long-term follow-up of high-risk allogeneic peipheral-blood stem-cell transplant recipients: graft-versus-host disease and transplant-related mortality. J Clin Oncol 1999; 17: 806–812.

    Article  CAS  PubMed  Google Scholar 

  43. Champlin RE, Schmitz N, Horowitz M et al. Blood stem cells compared with bone marrow as a source of hematopoietic cells for allogeneic transplantation. Blood 2000; 95: 3702–3709.

    CAS  PubMed  Google Scholar 

  44. Majolino I, Saglio G, Scime R et al. High incidence of chronic GVHD after primary allogeneic peripheral blood stem cell transplantation in patients with hematologic malignancies. Bone Marrow Transplant 1996; 17: 555–560.

    CAS  PubMed  Google Scholar 

  45. Vigorito AC, Azevedo WM, Marques JFC et al. A randomised, prospective comparison of allogeneic bone marrow and peripheral blood progenitor cell transplantation in the treatment of haematological malignancies. Bone Marrow Transplant 1998; 22: 1145–1151.

    Article  CAS  PubMed  Google Scholar 

  46. Cutler C, Giri S, Jeyapalan S et al. Acute and chronic graft-versus-host disease after allogeneic peripheral-blood stem-cell and bone marrow transplantation: a meta-analysis. J Clin Oncol 2001; 19: 3685–3691.

    Article  CAS  PubMed  Google Scholar 

  47. Bearman SI, Petersen FB, Schor RA et al. Radionuclide ejection fractions in the evaluation of patients being considered for bone marrow transplantation: risk for cardiac toxicity. Bone Marrow Transplant 1990; 5: 173–177.

    CAS  PubMed  Google Scholar 

  48. Hertenstein B, Stefanic M, Schmeiser T et al. Cardiac toxicity of bone marrow transplantation: predictive value of cardio-logic evaluation before transplant. J Clin Oncol 1994; 12: 998–1004.

    Article  CAS  PubMed  Google Scholar 

  49. Jain B, Floreani AA, Anderson JR et al. Cardiopulmonary function and autologous bone marrow transplantation: results and predictive value for respiratory failure and mortality. Bone Marrow Transplant 1996; 17: 561–568.

    CAS  PubMed  Google Scholar 

  50. Zangari M, Henzlova MJ, Ahmad S et al. Predictive value of left ventricular ejection fraction in stem cell transplantation. Bone Marrow Transplant 1999; 23: 917–920.

    Article  CAS  PubMed  Google Scholar 

  51. Fujimaki K, Maruta A, Yoshida M et al. Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction. Bone Marrow Transplant 2001; 27: 307–310.

    Article  CAS  PubMed  Google Scholar 

  52. Crawford SW, Fisher L . Predictive value of pulmonary function tests before marrow transplantation. Chest 1992; 101: 1257–1264.

    Article  CAS  PubMed  Google Scholar 

  53. Hovak DA, Schmidt GM, Zaia JA et al. Pretransplant pulmonary function predicts cytomegalovirus-associated interstitial pneumonia following bone marrow transplantation. Chest 1992; 102: 1484–1490.

    Article  Google Scholar 

  54. Carlson K, Bäcklund L, Smedmyr B et al. Pulmonary function and complications subsequent to autologous bone marrow transplantation. Bone Marrow Transplant 1994; 14: 805–811.

    CAS  PubMed  Google Scholar 

  55. Goldberg SL, Klumpp TR, Magdalinski AJ et al. Value of the pretransplant evaluation in predicting toxic day-100 mortality among blood stem-cell and bone marrow transplant recipients. J Clin Oncol 1998; 16: 3796–3802.

    Article  CAS  PubMed  Google Scholar 

  56. Cazin B, Gorin NC, Laporte JP et al. Cardiac complications after bone marrow transplantation. Cancer 1986; 57: 2061–2069.

    Article  CAS  PubMed  Google Scholar 

  57. Cordonnier C, Bernaudin J, Bierling P et al. Pulmonary complications occurring after allogeneic bone marrow transplantation. Cancer 1986; 58: 1047–1054.

    Article  CAS  PubMed  Google Scholar 

  58. Badier M, Guillot C, Delpierre S et al. Pulmonary function changes 100 days and one year after bone marrow transplantation. Bone Marrow Transplant 1993; 12: 457–461.

    CAS  PubMed  Google Scholar 

  59. Krowka MJ, Rosenow ED, Hoagland HC . Pulmonary complications of bone marrow transplantation. Chest 1985; 87: 237–246.

    Article  CAS  PubMed  Google Scholar 

  60. Wingard JR, Piantadosi S, Vogelsang GB et al. Predictors of death from chronic graft-versus-host disease after bone marrow transplantation. Blood 1989; 74: 1428–1435.

    CAS  PubMed  Google Scholar 

  61. Loughran TP, Sullivan K, Morton T et al. Value of day 100 screening studies for predicting the development of chronic graft-versus-host disease after allogeneic bone marrow transplantation. Blood 1990; 76: 228–234.

    PubMed  Google Scholar 

  62. Wagner JL, Flowers MED, Longton G et al. The development of chronic graft-versus-host disease: an analysis of screening studies and the impact of corticosteroid use at 100 days after transplantation. Bone Marrow Transplant 1998; 22: 139–146.

    Article  CAS  PubMed  Google Scholar 

  63. First LR, Smith BR, Lipton J et al. Isolated thrombocytopenia after allogeneic bone marrow transplantation: existence of transient and chronic thrombocytopenic syndromes. Blood 1985; 65: 368–374.

    CAS  PubMed  Google Scholar 

  64. Sullivan KM, Witherspoon RP, Storb R et al. Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-versus-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation. Blood 1988; 72: 546–554.

    CAS  PubMed  Google Scholar 

  65. Przepiorka D, Anderlini P, Saliba R et al. Chronic graft-versus-host disease after allogeneic blood stem cell transplantation. Blood 2001; 98: 1695–1700.

    Article  CAS  PubMed  Google Scholar 

  66. Wagner JL, Flowers M, Longton G et al. Use of screening studies to predict survival among patients who do not have chronic graft-versus-host disease at day 100 after bone marrow transplantation. Biol Blood Marrow Transplant 2001; 7: 239–240.

    Article  CAS  PubMed  Google Scholar 

  67. Bolwell BJ, Pohlman B, Sobecks R et al. Survival after allogeneic BMT: the prognostic importance of the platelet count 100 days post transplant. Proc Am Soc Hematol 2002; 100: 416 (abstract).

    Google Scholar 

  68. Bacigalupo A, Oneto R, Bruno B et al. Early predictors of transplant-related mortality (TRM) after allogeneic bone marrow transplants (BMT): blood urea nitrogen (BUN) and bilirubin. Bone Marrow Transplant 1999; 24: 653–659.

    Article  CAS  PubMed  Google Scholar 

  69. Powles R, Kulkarni S, Sirohi B et al. Predictive model based on day 7 parameters to predict the risk of treatment related mortality (TRM) in patients undergoing allogeneic hematopoietic-stem cell transplant (AHSCT). Proc Am Soc Hematol 2002; 100: 412 (abstract).

    Google Scholar 

  70. Deeg HJ, Sidel K, Bruemmer B et al. Impact of patient weight on non-relapse mortality after marrow transplantation. Bone Marrow Transplant 1995; 15: 461–468.

    CAS  PubMed  Google Scholar 

  71. Porrata LF, Ingle JN, Litzow MR et al. Prolonged survival associated with early lymphocyte recovery after autologous hematopoietic stem cell transplantation for patients with metastatic breast cancer. Bone Marrow Transplant 2001; 28: 865–871.

    Article  CAS  PubMed  Google Scholar 

  72. Porrata LF, Gertz MA, Inwards DJ et al. Early lymphocyte recovery predicts superior survival after autologous hematopoietic stem cell transplantation in multiple myeloma or non-Hodgkin lymphoma. Blood 2001; 98: 579–585.

    Article  CAS  PubMed  Google Scholar 

  73. Pavletic ZS, Joshi SS, Pirruccello SJ et al. Lymphocyte reconstitution after allogeneic blood stem cell transplantation for hematologic malignancies. Bone Marrow Transplant 1998; 21: 33–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Schots R, Van Riet I, Othman TB 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 2002; 30: 441–446.

    Article  CAS  PubMed  Google Scholar 

  75. Loberiza FR, Rizzo JD, Bredeson CN et al. Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol 2002; 20: 2118–2126.

    Article  PubMed  Google Scholar 

  76. Bolwell BJ, Foster L, McLellan L et al. The presence of a caregiver is a powerful prognostic variable of survival following allogeneic bone marrow transplantation. Proc Am Soc Hematol 2001; 98: 202A (abstract 845).

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hematology and Medical Oncology, Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH, USA

    B J Bolwell

Authors
  1. B J Bolwell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B J Bolwell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bolwell, B. Are predictive factors clinically useful in bone marrow transplantation?. Bone Marrow Transplant 32, 853–861 (2003). https://doi.org/10.1038/sj.bmt.1704267

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1704267

Keywords

This article is cited by

Search

Advanced search

Quick links