Association of uric acid levels before start of conditioning with mortality after allogeneic hematopoietic stem cell transplantation - a prospective, non-interventional study of the EBMT Transplant Complication Working Party
Por:
Penack, O, Peczynski, C, van der Werf, S, Finke, J, Ganser, A, Schoemans, H, Pavlu, J, Niittyvuopio, R, Schroyens, W, Kaynar, L, Blau, IW, van der Velden, W, Sierra, J, Cortelezzi, A, Wulf, G, Turlure, P, Rovira, M, Ozkurt, Z, Pascual-Cascon, MJ, Moreira, MC, Clausen, J, Greinix, H, Duarte, RF, Basak, GW
Publicada:
1 jul 2020
Resumen:
Uric acid is a danger signal contributing to inflammation. Its relevance to allogeneic stem cell transplantation (alloSCT) derives from preclinical models where the depletion of uric acid led to improved survival and reduced graft-versus-host disease (GvHD). In a clinical pilot trial, peri-transplant uric acid depletion reduced acute GvHD incidence. This prospective international multicenter study aimed to investigate the association of uric acid serum levels before start of conditioning with alloSCT outcome. We included patients with acute leukemia, lymphoma or myelodysplastic syndrome receiving a first matched sibling alloSCT from peripheral blood, regardless of conditioning. We compared outcomes between patients with high and low uric acid levels with univariate- and multivariate analysis using a cause-specific Cox model. Twenty centers from 10 countries reported data on 366 alloSCT recipients. There were no significant differences in terms of baseline co-morbidity and disease stage between the high- and low uric acid group. Patients with uric acid levels above median measured before start of conditioning did not significantly differ from the remaining in terms of acute GvHD grades II-IV incidence (Hazard ratio [HR] 1.5, 95% Confidence interval [CI]: 1.0-2.4, P=0.08). However, they had significantly shorter overall survival (HR 2.8, 95% CI: 1.7-4.7, P<0.0001) and progression free survival (HR 1.6, 95% CI: 1.1-2.4, P=0.025). Non-relapse mortality was significantly increased in alloSCT recipients with high uric acid levels (HR 2.7, 95% CI: 1.4-5.0, P=0.003). Finally, the incidence of relapse after alloSCT was increased in patients with higher uric acid levels (HR 1.6, 95% CI: 1.0-2.5, P=0.04). We conclude that high uric acid levels before the start of conditioning correlate with increased mortality after alloSCT.
Filiaciones:
Penack, O:
Charite Univ Med Berlin, Berlin, Germany
Peczynski, C:
EBMT Stat Unit, Paris, France
van der Werf, S:
EBMT Data Off, Leiden, Netherlands
Finke, J:
Univ Freiburg, Freiburg, Germany
Ganser, A:
Hannover Med Sch, Hannover, Germany
Schoemans, H:
Univ Hosp Leuven, Dept Hematol, Leuven, Belgium
Katholieke Univ Leuven, Leuven, Belgium
Pavlu, J:
Imperial Coll, London, England
Niittyvuopio, R:
HUCH Comprehens Canc Ctr, Helsinki, Finland
Schroyens, W:
Antwerp Univ Hosp, Antwerp, Belgium
Kaynar, L:
Erciyes Univ, Fac Med, Kayseri, Turkey
Blau, IW:
Charite Univ Med Berlin, Berlin, Germany
van der Velden, W:
Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands
Sierra, J:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Cortelezzi, A:
Fdn IRCCS Ca Granda, Milan, Italy
Wulf, G:
Univ Klinikum Gottingen, Gottingen, Germany
Turlure, P:
CHRU Limoges, Limoges, France
Rovira, M:
Hosp Clin Barcelona, Barcelona, Spain
Ozkurt, Z:
Gazi Univ, Fac Med, Ankara, Turkey
Pascual-Cascon, MJ:
Hosp Reg Malaga, Malaga, Spain
Moreira, MC:
Inst Natl Canc, Rio De Janeiro, Brazil
Clausen, J:
Elisabethinen Hosp, Linz, Austria
Greinix, H:
LKH Univ Hosp Graz, Graz, Austria
Duarte, RF:
Hosp Univ Puerta Hierro, Madrid, Spain
Basak, GW:
Med Univ Warsaw, Warsaw, Poland
Gold, Green Published
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