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ORIGINAL ARTICLE
Year : 2018  |  Volume : 43  |  Issue : 2  |  Page : 76-84

Pretransplant C-reactive protein, ferritin, albumin, and platelet count as prognostic biomarkers of hematopoietic stem cell transplantation outcome in hematological malignancies


1 Department of Internal Medicine and Hematology, Ain Shams University, Cairo, Egypt
2 Department of Hematology, El Maadi Armed Forces Hospital, Cairo, Egypt

Correspondence Address:
Haydi S Mohamed
Lecturer of Internal Medicine and Hematology, 52 El Saudia Buildings, 11281
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejh.ejh_47_17

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Aim To study the prediction of prognosis after hematopoietic stem cell transplantation (HSCT) by clinically available biomarkers prior to transplantation (CRP, Ferritin, albumin and platelet count). Background Previous studies have shown that a number of objective laboratory “biomarkers” are of interest in pre-HSCT risk-assessment: Serum albumin inversely correlates with age, smoking, obesity and hypertension, and predicts cardiovascular mortality. Serum ferritin is an acute phase reactant, and elevated levels suggest iron overload, which has been linked to post-HSCT infections. Finally low platelet count, could indicate poor marrow function related to persistent malignancy or effects of prior treatment. Methods The study included patients admitted at the Bone marrow transplantation Units in Egypt (Ain Shams University Hospitals and Maadi Armed Forces Medical Compound and Sheikh Zayed Specialized Hospital) between August 2015 and December 2016. The study population consisted of 30 adults aged from 18 to 60 years; 26 patients were subjected to autologous-HSCT to treat high-risk or relapsing NHL, MM, relapsing HL, and 4 patients subjected to allogeneic-HSCT to treat 1st complete remissiom (CR) AML, 2nd CR AML. The biomarkers included pre-transplant serum albumin, platelet count, C-reactive protein (CRP) and serum ferritin were centrally quantified by (ELISA) technique. All patients were followed up till day +90 post transplant. Results Shock developed post-transplant in patients with CRP ˃10 mg/L (P=0.026) while non-relapse mortality was associated with the pre-specified thresholds of platelet count <150,000/μl (P=0.046) but not CRP ˃10 mg/L (P=0.1) and s.albumin <3.5 g/dL (P=0.3) and s.ferritin <2500 ng/mL. (P=0.9). Three months overall survival (OS) was 87% among the studied group. Mean survival time was associated with low platelet count <150,000/μl (P=0.024) not with CRP ˃10 mg/L (P=0.1) and s.albumin <3.5 g/dL (P=0.6) and s.ferritin <2500 ng/mL (P=0.9). Conclusion We conclude that elevated level of pre-transplant CRP, s.ferritin associated with high NRM without statistically significant difference while NRM was higher in patients with normal s.albumin pre-transplant without statistically significant difference, low platelet count <150,000/μl associated with increased NRM with statistically significant difference (P=0.046), and lower survival the 3 months overall survival (OS) among patients was about 87%. Mean survival time was statistically significant in patients with low platelet count (P=0.024) not in CRP, ferritin and albumin.


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