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Post-Transplant Complications

A revised day +7 predictive score for transplant-related mortality: serum cholinesterase, total protein, blood urea nitrogen, γ glutamyl transferase, donor type and cell dose

Bone Marrow Transplantation volume 32, pages 205–211 (2003)Cite this article

Summary:

We have previously described a scoring system for patients undergoing hemopoietic stem cell transplantation (HSCT) based on day +7 blood urea nitrogen (BUN) and serum bilirubin levels. We have revised that scoring system using a formal multivariate approach based on a training phase (305 patients) and a validation phase (217 patients). Day +7 BUN, serum cholinesterase (CHE), total proteins (TP), gamma glutamyl transferase (γGT), donor type and cell dose at transplant were included in the new score. The score distribution identified three groups of patients in the training set (<25, 25-75, >75 percentile of the score) which were classified as low, intermediate and high risk. Their actuarial risk of transplant-related mortality (TRM) at 6 years was, respectively, 12, 38 and 60%. In the validation set the 6 year actuarial TRM was, respectively, 15, 40 and 69%. High risk patients had more graft-versus-host disease (GvHD) (P<0.0001) and lower platelet counts (P<0.0001). This study confirms that GvHD and TRM can be predicted on day +7 after HSCT: pre-emptive GvHD therapy may be one option for high-risk patients and is being tested in a prospective randomized trial. The score for single patients can be calculated on the web site http://213.26.110.20/lrm/day_seven_score.html.

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Acknowledgements

This work was supported by Associazione Italiana Ricerca contro il Cancro (AIRC) Milano grant to AB and Associazione Ricerca Trapianto Midollo Osseo (ARITMO) Genova. The great work of our nursing staff is gratefully acknowledged. The BMT transplant group from Hospital Gaslini, Genova, Italy is also gratefully aknowledged.

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Authors and Affiliations

  1. Divisione Ematologia II Ospedale San Martino, Genova, Italy

    R Oneto, B Bruno, M Fiorone, T Lamparelli, F Gualandi, A M Raiola, A Dominietto, M T Van Lint, F Frassoni & A Bacigalupo

  2. Unita' Epidemiologia Clinica, Istituto Scientifio Tumori, Genova

    M P Sormani & P Bruzzi

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  1. M P Sormani
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Appendix : Prediction of risk of TRM

Appendix : Prediction of risk of TRM

In order to predict the risk of TRM for a new patient undergoing HSCT using the predictive model built on the training set and validated on the validation set, the following procedure can be followed. First, the score for that patient can be calculated using the formula:

where CHE, TP, BUN and γGT assume the values 0, 1 or 2 according to the following criteria: (See Table A)

CHE=IU/dl; TP=gr/dl; BUN= mg/dl; γGT=IU/dl; donor type is 0 if it is an HLA-identical sibling and 1 if otherwise.

Second, the probability of TRM for the patient with a score=x, can be calculated by:

where Sx is calculated applying the formula reported in the Methods:

In our sample S0 (survival for a patient with all variables set as their mean values) is=0.66 and β=0.83.

Let us imagine a patient grafted from an HLA-identical sibling (donor type=0) who received 2.1 × 108 cells/kg, with day +7 CHE=4599, BUN=17, TP=5.4, γGT=78: from the table, we transform these values as CHE=2, BUN=0, TP=0, γGT=1, donor type=0. Using these transformed values, we calculate the score for that patient:

And the TRM at day 2500 is

This patients, with a probability of TRM at day 2500=23% is considered as low-risk patient.

Alternatively, one can log in to the web site http://213.26.110.20/lrm/day_seven_score.html and fill in the fields as indicated (cell dose × 108/kg, type of donor, day +7 value for CHE. TP, γGT, BUN: the program will calculate the score for that patient and indicate if he is low- intermediate- or high risk).

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Sormani, M., Oneto, R., Bruno, B. et al. A revised day +7 predictive score for transplant-related mortality: serum cholinesterase, total protein, blood urea nitrogen, γ glutamyl transferase, donor type and cell dose. Bone Marrow Transplant 32, 205–211 (2003). https://doi.org/10.1038/sj.bmt.1704085

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