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Reply to the letter by Morris et al

Bone Marrow Transplantation volume 33, page 123 (2004)Cite this article

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In this report, Morris et al describe three patients with refractory malignant disease, who died of an ARDS-like syndrome within the first few weeks after autologous stem cell transplantation (autoSCT). These patients were found to have increased pretransplant serum levels of C-reactive protein (CRP), as compared with a group of 21 patients who survived the transplant procedure. Post transplant levels of CRP did not differ significantly between groups. The authors found no additional value in measuring cytokine levels, including IL-6 and TNF-alpha, either pre- or post transplant.

The observation of Morris et al is based on a low number of patients, which prompts caution with respect to the value of the statistical analysis. For example, post transplant CRP levels in patients developing transplant-related mortality (TRM+) are clearly higher (medians of 185 vs 30 mg/l), but the number of patients is too low to show the difference. Also, the highest levels are included in the analysis, whereas the duration of elevated CRP and cytokine levels is not specified. In our experience, sustained increases are more relevant than short peak levels. Nevertheless, the findings of Morris et al suggest that high CRP levels before transplant may be helpful in identifying patients at risk of TRM after autoSCT.

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References

  1. Schots R, Van Riet I, Othman TB et al. An early increase in serum levels of C-reactive protein is an independent risk factor for the occurrence of major complications and 100-day transplant-related mortality after allogeneic bone marrow transplantation. Bone Marrow Transplant 2002; 30: 441–446.

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  2. Schots R, Kaufman L, Van Riet I et al. Proinflammatory cytokines and their role in the development of major transplant-related complications in the early phase after allogeneic bone marrow transplantation. Leukemia 2003; 17: 1150–1156.

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  1. BMT-Unit, AZ-Vrije Universiteit Brussel, Laarbeeklaan 101, Brussel, 1090, Belgium

    R Schots

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  1. R Schots
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Schots, R. Reply to the letter by Morris et al. Bone Marrow Transplant 33, 123 (2004). https://doi.org/10.1038/sj.bmt.1704306

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