We sought to confirm the prognostic importance of simple clinically available biomarkers of c-reactive protein, serum albumin, and ferritin prior to allogeneic hematopoietic cell transplantation. The study population consisted of 784 adults with acute myeloid leukemia in remission or myelodysplastic syndromes undergoing unrelated donor transplant reported to the Center for International Blood and Marrow Transplant Research. C-reactive protein and ferritin were centrally quantified by ELISA from cryopreserved plasma whereas each center provided pre-transplant albumin. In multivariate analysis, transplant related mortality was associated with the pre-specified thresholds of c-reactive protein > 10 mg/L (P = .008) and albumin < 3.5 g/dL (P = .01) but not ferritin > 2500 ng/mL. Only low albumin independently influenced overall mortality. Optimal thresholds affecting transplant-related mortality were defined as: c-reactive protein > 3.67 mg/L, log(ferritin), and albumin < 3.4 g/dL . A three level biomarker risk group based on these values separated risks of transplant related mortality: low risk (reference), intermediate (HR=1.66, P =.015), and high risk (HR= 2.7, P < .001). One year survival was 74%, 67% and 56% for low, intermediate and high risk groups. Routinely available pre-transplant biomarkers independently risk-stratify for transplant-related mortality and survival.
- myelodysplastic syndromes (MDS)