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Elevated pre-transplant C-reactive protein identifies a high-risk subgroup in multiple myeloma patients undergoing delayed autologous stem cell transplantation

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Abstract

The significance of elevated C-reactive protein (CRP) prior to autologous stem cell transplantation (ASCT) in multiple myeloma (MM) has not been studied. We analyzed 1111 MM patients who underwent ASCT at Mayo Clinic from 2007 to 2015. A total of 840 patients (76%) received early ASCT (12 months from diagnosis) and 271 patients (24%) received delayed ASCT (>12 months from diagnosis). Elevated CRP (> upper normal limit (8 mg/L)) was seen in 14% and 22% of patients undergoing early and delayed ASCT, respectively (P=0.003). There was no correlation of CRP with pre-transplant response, bone marrow plasma cell percentage or labeling index. Patients with an elevated CRP had a higher likelihood of having circulating plasma cells prior to ASCT (33 vs 19%; P<0.001). In the early ASCT cohort, the median overall survival (OS) in patients with normal and elevated CRP was not reached and 91 months respectively (P=0.011). In the delayed ASCT cohort, the median OS in respective groups were 73 and 30 months respectively (P<0.001), with elevated CRP being an independent prognostic marker on multivariate analysis (hazard ratio 2.0; 95% confidence interval, 1.0–3.8; P=0.045). Elevated pre-transplant CRP identifies a high-risk population especially in patients undergoing delayed ASCT and should be incorporated in the pre-transplant evaluation.

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Acknowledgements

Author contributions

RC designed the study, analyzed the data, wrote the first draft and approved the final version of the manuscript. MAG designed the study, analyzed the data, wrote the first draft and approved the final version of the manuscript. EM designed the study, analyzed the data, revised the manuscript critically and approved the final version of the manuscript. MAG, SKK, FKB, DD, AD, SRH, WJH, PK, MQL and NL performed patient management, revised the manuscript critically, participated in final data analysis and approved the final version of the manuscript.

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Correspondence to M A Gertz.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Chakraborty, R., Muchtar, E., Kumar, S. et al. Elevated pre-transplant C-reactive protein identifies a high-risk subgroup in multiple myeloma patients undergoing delayed autologous stem cell transplantation. Bone Marrow Transplant 53, 155–161 (2018). https://doi.org/10.1038/bmt.2017.228

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