Helmholtz Gemeinschaft


Early bilirubinemia after allogeneic stem cell transplantation - an endothelial complication

PDF (Original Article) - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
[img] Other (Supplementary Information)

Item Type:Article
Title:Early bilirubinemia after allogeneic stem cell transplantation - an endothelial complication
Creators Name:Dai, H. and Penack, O. and Radujkovic, A. and Schult, D. and Majer-Lauterbach, J. and Blau, I.W. and Bullinger, L. and Jiang, S. and Müller-Tidow, C. and Dreger, P. and Luft, T.
Abstract:Hyperbilirubinemia occurs frequently after allogeneic stem cell transplantation. Causes include primary liver damage and endothelial complications as major contributors. Here, we have investigated the impact of early bilirubinemia (EB) on posttransplant outcomes. Maximum total bilirubin levels (days 0-28) were categorized using maximally selected log rank statistics to identify a cut off for the endpoint non-relapse mortality (NRM) in a training cohort of 873 patients. EB above this cut off was correlated with NRM and overall survival (OS) and with pre- and posttransplant Angiopoietin-2, interleukin (IL)18, CXCL8 and suppressor of tumorigenicity-2 (ST2) serum levels, and the endothelial activation and stress index (EASIX). Clinical correlations were validated in a sample of 388 patients transplanted in an independent institution. The EB cut off was determined at 3.6 mg/dL (61.6 mu M). EB predicted OS (HR 1.60, 95% CI 1.21-2.12, p < 0.001), and NRM (CSHR 2.14; 1.28-3.56, p = 0.004), also independent of typical endothelial complications such as veno-occlusive disease, refractory acute graft-versus-host disease, or transplant-associated microangiopathy. However, EB correlated with high Angiopoietin-2, EASIX-pre and EASIX-day 0, as well as increased levels of posttransplant CXCL8, IL18, and ST2. In summary, EB indicates a poor prognosis. The association of EB with endothelial biomarkers suggests an endothelial pathomechanism also for this posttransplant complication.
Keywords:Endothelium, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Homologous Transplantation, Hyperbilirubinemia, Retrospective Studies
Source:Bone Marrow Transplantation
Publisher:Nature Publishing Group
Page Range:1573-1583
Date:July 2021
Official Publication:https://doi.org/10.1038/s41409-020-01186-6
PubMed:View item in PubMed

Repository Staff Only: item control page


Downloads per month over past year

Open Access
MDC Library