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 Characteristics

VariableCR @ SCTNo CR @ SCTp
CRP nl range (<0.8 mg/dl) BNP nl range (0–100 pg/dl) NS= non significant 
Median Age, range 48 (22–70) 54 (21–69) 0.005 
Time to SCT 9 m (3–62) 11 m (2–69) NS 
% 6/6 Sibling 47 32 NS 
% 6/6 MUD 38 47 NS 
Other Donor 15 21 NS 
Seattle HCT Score 0–1 24% 15% NS 
Seattle HCT Score 2–4 60% 45% NS 
Seattle HCT Score >4 15% 40% 0.02 
% RIC 36% 55% .05 
CRP median 0.31 1.1 <0.001 
BNP median 29 74 <0.001 
VariableCR @ SCTNo CR @ SCTp
CRP nl range (<0.8 mg/dl) BNP nl range (0–100 pg/dl) NS= non significant 
Median Age, range 48 (22–70) 54 (21–69) 0.005 
Time to SCT 9 m (3–62) 11 m (2–69) NS 
% 6/6 Sibling 47 32 NS 
% 6/6 MUD 38 47 NS 
Other Donor 15 21 NS 
Seattle HCT Score 0–1 24% 15% NS 
Seattle HCT Score 2–4 60% 45% NS 
Seattle HCT Score >4 15% 40% 0.02 
% RIC 36% 55% .05 
CRP median 0.31 1.1 <0.001 
BNP median 29 74 <0.001 
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Outcomes

IN CR PRE SCT> Grade 3 ToxpOS @ 1 yearHR (p)NRM @ 1 yearHR (p)
qtl=quartile; ne=not evaluable 
CRP≤ median 8%  72%  0%  
CRP > median 12% 0.5 37% 3.0 (0.09) 52% ne (0.007) 
CRP≤ 1st qtl 8%  100%  0%  
CRP > 1st qtl 10% 0.6 38% ne (0.03) 41% ne (0.09) 
BNP≤ 1st qtl 7%  61%  21%  
BNP > 1st qtl 10% 0.6 36% 0.8 (0.7) 47% 0.5 (0.4) 
NOT IN CR PRE SCT       
CRP≤ median 8%  39%  10%  
CRP > median 25% 0.1 50% 1.1 (0.8) 14% 1.6 (0.6) 
CRP≤ 1st qtl 7%  71%  0%  
CRP > 1st qtl 19% 0.3 39% 0.5 (0.2) 16% ne (0.1) 
BNP≤ 1st qtl 0%  58%  8%  
BNP > 1st qtl 20% 0.07 45% 0.9 (0.9) 12% 0.8 (0.8) 
IN CR PRE SCT> Grade 3 ToxpOS @ 1 yearHR (p)NRM @ 1 yearHR (p)
qtl=quartile; ne=not evaluable 
CRP≤ median 8%  72%  0%  
CRP > median 12% 0.5 37% 3.0 (0.09) 52% ne (0.007) 
CRP≤ 1st qtl 8%  100%  0%  
CRP > 1st qtl 10% 0.6 38% ne (0.03) 41% ne (0.09) 
BNP≤ 1st qtl 7%  61%  21%  
BNP > 1st qtl 10% 0.6 36% 0.8 (0.7) 47% 0.5 (0.4) 
NOT IN CR PRE SCT       
CRP≤ median 8%  39%  10%  
CRP > median 25% 0.1 50% 1.1 (0.8) 14% 1.6 (0.6) 
CRP≤ 1st qtl 7%  71%  0%  
CRP > 1st qtl 19% 0.3 39% 0.5 (0.2) 16% ne (0.1) 
BNP≤ 1st qtl 0%  58%  8%  
BNP > 1st qtl 20% 0.07 45% 0.9 (0.9) 12% 0.8 (0.8) 
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Topics:
allogeneic stem cell transplant, brain natriuretic peptide, c-reactive protein, leukemia, myelocytic, acute, myelodysplastic syndrome, transplantation, brain natriuretic peptide measurement, toxic effect, allopurinol, amyloidosis

Author notes

Disclosure:Off Label Use: Most products used have no nidication for stem cell transplantation in acute leukemia or MDS.

2007, The American Society of Hematology
2007
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