Hypoalbuminemia at Day +90 Is Associated with Inferior Nonrelapse Mortality and Overall Survival in Allogeneic Hematopoietic Cell Transplantation Recipients: A Confirmatory Study

Hemant S. Murthy, Kyle Sheets, Ambuj Kumar, Taiga Nishihori, Alain Mina, Julio C. Chavez, Ernesto Ayala, Teresa Field, John Mathews, Frederick Locke, Lia Perez, Brian C. Betts, Farhad Khimani, Branco Miladinovic, Athanasios Tsalatsanis, Jose Leonel Ochoa-Bayona, Melissa Alsina, Hugo Fernandez, Joseph Pidala, Claudio AnasettiMohamed A. Kharfan-Dabaja

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Prognostic biomarkers in allogeneic hematopoietic cell transplantation (allo-HCT) are needed to improve risk assessment and help guide therapeutic and surveillance strategies to mitigate the risk of death from the procedure. We previously identified hypoalbuminemia at day +90 post-transplantation as an independent predictor of increased nonrelapse mortality (NRM) and inferior overall survival (OS) in patients with acute myelogenous leukemia and myelodysplastic syndrome who were treated with an allo-HCT. Here, we aim to confirm the prognostic significance of day +90 hypoalbuminemia in 783 patients, median age 52 years (range, 18 to 76), who received an allo-HCT for various hematologic malignancies and bone marrow failure syndromes. Multivariate analysis for NRM demonstrated a negative effect of low serum albumin levels (<3.0 versus 3.0 to 3.5 versus >3.5 g/dL) at day +90 post-transplantation (hazard ratios, 8.03 [95% CI, 3.59 to 17.97] versus 2.84 [95% CI, 1.59 to 5.08] versus reference; P <.0001). This was also the case for OS (hazard ratios, 6.86 [95% CI, 4.24 to 11.10] versus 1.52 [95% CI, 1.05 to 2.20] versus reference; P <.0001). Patients with hypoalbuminemia at day +90 post-transplantation are more likely to die from causes other than relapse, particularly infections. This large study confirms the ability of day +90 serum hypoalbuminemia to predict worse NRM and inferior OS. Presence of hypoalbuminemia at day +90 should drive a more rigorous real-time surveillance strategy considering the anticipated high-risk of NRM and poor survival in these patients. Future studies should consider incorporating day +90 serum albumin levels in prognostic models of NRM and OS.

Original languageEnglish (US)
Pages (from-to)400-405
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume24
Issue number2
DOIs
StatePublished - Feb 2018

Keywords

  • Allogeneic hematopoietic cell transplantation
  • Hypoalbuminemia
  • Nonrelapse mortality
  • Overall survival

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