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Influence of lactate dehydrogenase and cyclosporine A level on the incidence of acute graft-versus-host disease after allogeneic stem cell transplantation.

Song MK, Chung JS, Seol YM, Kwon BR, Shin HJ, Choi YJ, Cho GJ - J. Korean Med. Sci. (2009)

Bottom Line: An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia.Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment).We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea.

ABSTRACT
Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.

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The cumulative incidence of aGVHD of the two serum CsA groups at the third week after transplantation. A higher CsA level was associated with a lower incidence of aGVHD above grade II (P=0.0004).aGVHD, acute graft-versus-host disease; HCsA, higher cyclosporine A; LCsA, lower cyclosporine A.
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Figure 1: The cumulative incidence of aGVHD of the two serum CsA groups at the third week after transplantation. A higher CsA level was associated with a lower incidence of aGVHD above grade II (P=0.0004).aGVHD, acute graft-versus-host disease; HCsA, higher cyclosporine A; LCsA, lower cyclosporine A.

Mentions: The serum CsA level was measured every other day, and the CsA dose was adjusted to maintain the serum CsA level between 200 and 400 ng/mL. When the patients were grouped according to the mean serum CsA level during each week, into the above 300 ng/mL group (mean CsA level 332.1±15, higher CsA group; HCsA group) and the below 300 ng/mL group (mean CsA level 231.3±28, lower CsA group; LCsA group), serum levels in the first and second week were not correlated with the incidence of aGVHD above grade II (P=0.320) (Table 4). However, in the third week, the HCsA group showed a significantly lower cumulative incidence of aGVHD above grade II compared to the LCsA group (P=0.015) (Table 2, Fig. 1). There were no significant differences in sex, age, stem cell source, conditioning regimen, cell dose, or time to engraftment between the HCsA and the LCsA group in the third week (Table 2).


Influence of lactate dehydrogenase and cyclosporine A level on the incidence of acute graft-versus-host disease after allogeneic stem cell transplantation.

Song MK, Chung JS, Seol YM, Kwon BR, Shin HJ, Choi YJ, Cho GJ - J. Korean Med. Sci. (2009)

The cumulative incidence of aGVHD of the two serum CsA groups at the third week after transplantation. A higher CsA level was associated with a lower incidence of aGVHD above grade II (P=0.0004).aGVHD, acute graft-versus-host disease; HCsA, higher cyclosporine A; LCsA, lower cyclosporine A.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2719215&req=5

Figure 1: The cumulative incidence of aGVHD of the two serum CsA groups at the third week after transplantation. A higher CsA level was associated with a lower incidence of aGVHD above grade II (P=0.0004).aGVHD, acute graft-versus-host disease; HCsA, higher cyclosporine A; LCsA, lower cyclosporine A.
Mentions: The serum CsA level was measured every other day, and the CsA dose was adjusted to maintain the serum CsA level between 200 and 400 ng/mL. When the patients were grouped according to the mean serum CsA level during each week, into the above 300 ng/mL group (mean CsA level 332.1±15, higher CsA group; HCsA group) and the below 300 ng/mL group (mean CsA level 231.3±28, lower CsA group; LCsA group), serum levels in the first and second week were not correlated with the incidence of aGVHD above grade II (P=0.320) (Table 4). However, in the third week, the HCsA group showed a significantly lower cumulative incidence of aGVHD above grade II compared to the LCsA group (P=0.015) (Table 2, Fig. 1). There were no significant differences in sex, age, stem cell source, conditioning regimen, cell dose, or time to engraftment between the HCsA and the LCsA group in the third week (Table 2).

Bottom Line: An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia.Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment).We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Busan, Korea.

ABSTRACT
Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.

Show MeSH
Related in: MedlinePlus