Pre Transplant Values of C Reactive Protein (CRP) and Brain Natriuretic Peptide (BNP) as Predictors of Transplant Outcomes in Patients with Acute Myelogenous Leukemia or Myelodysplastic Syndromes (AML/MDS) Undergoing Allogeneic Stem Cell Transplantation (AlloSCT).
Authors: Giralt Sergio , Saliba Rima M. , Mendoza Floralyn , Parikh Gaurav , Qureshi Suheil , Zhang Weiqing , Popat Uday , Qazilbash Muzaffar , Khouri Issa , Hosing Chitra , Alousi Amin , Anderlini Paolo , Andersson Borje , Jones Roy , Shpall Elizabeth , Kebriaei Partow , Nieto Yago , Ueno Naoto , Champlin Richard , de Lima Marcos 
Published: April 2020

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 Variable CR @ SCT No CR @ SCT p CRP nl range (&lt;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 &gt;4 15% 40% 0.02 % RIC 36% 55% .05 CRP median 0.31 1.1 &lt;0.001 BNP median 29 74 &lt;0.001 Outcomes IN CR PRE SCT &gt; Grade 3 Tox p OS @ 1 year HR (p) NRM @ 1 year HR (p) qtl=quartile; ne=not evaluable CRP≤ median 8% 72% 0% CRP &gt; median 12% 0.5 37% 3.0 (0.09) 52% ne (0.007) CRP≤ 1st qtl 8% 100% 0% CRP &gt; 1st qtl 10% 0.6 38% ne (0.03) 41% ne (0.09) BNP≤ 1st qtl 7% 61% 21% BNP &gt; 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 &gt; median 25% 0.1 50% 1.1 (0.8) 14% 1.6 (0.6) CRP≤ 1st qtl 7% 71% 0% CRP &gt; 1st qtl 19% 0.3 39% 0.5 (0.2) 16% ne (0.1) BNP≤ 1st qtl 0% 58% 8% BNP &gt; 1st qtl 20% 0.07 45% 0.9 (0.9) 12% 0.8 (0.8)