Work

Lower post-transplant serum albumin levels predict significantly poorer survival after allogeneic hematopoietic stem cell transplantation

Year: 2004

Type: article

Abstract: Low serum albumin is a non-specific but powerful indicator of poorer outcome in elderly and hospitalized patients, after surgery, and in several other circumstances including on routine testing (Goldwasser Feldman, J Clin Epidemiol 1997;50:693–703). Based upon the observation that patients with significant complications after transplantation usually have lower albumin levels and those with higher albumin levels are usually well, we analyzed the relationship between post-transplant albumin levels and overall survival in recipients of non-myeloablative allogeneic transplantation (NMAT). Overall survival (OS) was chosen as an endpoint rather than disease-free survival because a number of patients relapsing after NMAT attain remission again and survive long-term, and a higher albumin level after relapse may be a predictor of better outcome too. 47 consecutive NMAT recipients with hematologic malignancies (27–66 years; median 51) were studied. The conditioning regimen was 100 mg/m2 melphalan on day -1 (+ 50 mg/kg cyclophosphamide on day -2 if no prior autograft), cyclosporine (HLA-matched sibling donor; n = 32) or tacrolimus (1-locus mismatched sibling donor; n = 3, or unrelated donor; n = 12), and mycophenolate mofetil. Albumin levels on days 0, 30, 60 and 90, and average albumin levels over weeks 1–2, 3–4, 5–6, 7–8, 9–10, 11–12, and 13–16 were analyzed. All comparisons were for <3 vs ≥3 g/dL except weeks 1–2 and 3–4 where a <2.5 vs ≥2.5 g/dL cut-off was used because most patients had relatively low albumin levels for the first month. In each of the 11 comparisons, the group with the lower albumin level had a lower probability of OS at 18 months. The table shows the OS differences were statistically significant. This analysis confirms our clinical impression of the poor prognostic implication of low albumin levels after allogeneic transplantation. Further work is required to explore how the outcome of patients with low albumin can be improved by modifying medical management.TableTimeHigher AlbuminLower AlbuminPn1-y OS (95% CI) (%)n1-y OS (95% CI) (%)Day 602573 (51–94)1348 (19–78)0.01Weeks 1–22475 (56–94)2320 (0–51)0.01Weeks 3–42476 (56–97)2235 (9–61)0.01Weeks 5–62769 (48–90)1742 (17–67)0.02Weeks 7–82478 (58–97)1433 (5–62)0.003Weeks 9–102474 (54–94)1147 (14–79)0.05 Open table in a new tab

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2003.12.159