Hyperbilirubinemia in the early phase after allogeneic HSCT: prognostic significance of the alkaline phosphatase/total bilirubin ratio.

Abstract

Hyperbilirubinemia in the early phase after allogeneic hematopoietic SCT (HSCT) is due to various causes. One of the most important causes of hyperbilirubinemia is veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS). However, the prognosis of patients who are clinically diagnosed as SOS varies. We retrospectively evaluated 82 patients who underwent their first allogeneic HSCT. GVHD prophylaxis was a combination of short-term MTX and CsA (n=77) or tacrolimus (n=5). Thirty-three patients developed hyperbilirubinemia, with a bilirubin level of at least 2 mg/dL, within 20 days after HSCT. Of these patients, 24 were diagnosed as VOD/SOS using the modified Seattle criteria. Twenty-six recovered to a bilirubin level of <2 mg/dL. We focused on the serum alkaline phosphatase/total bilirubin ratio (ALP/TB) at the onset of hyperbilirubinemia and found that it significantly predicted the recovery from hyperbilirubinemia. OS was significantly higher in patients with a lower ALP/TB ratio (P=0.00056). In addition, a lower ALP/TB ratio was associated with better survival even in patients who were clinically diagnosed as SOS (P<0.001). The ALP/TB ratio at the onset of hyperbilirubinemia may be a useful predictor for the prognosis of hyperbilirubinemia and SOS early after HSCT.

• Authors: M Ashizawa, K Oshima, H Wada, Y Ishihara, K Kawamura, K Sakamoto, M Sato, K Terasako, T Machishima, S Kimura, M Kikuchi, H Nakasone, S Okuda, S Kako, J Kanda, R Yamazaki, A Tanihara, J Nishida, Y Kanda
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 48 Issue 1 Pg. 94-8 (Jan 2013) ISSN: 1476-5365 [Electronic] England
• PMID: 22750996 (Publication Type: Journal Article)

Chemical References

• Alkaline Phosphatase
• Bilirubin

Topics

• Adolescent
• Adult
• Aged
• Algorithms
• Alkaline Phosphatase (blood)
• Bilirubin (blood)
• Early Diagnosis
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Hepatic Veno-Occlusive Disease (diagnosis, epidemiology, etiology, physiopathology)
• Humans
• Hyperbilirubinemia (blood, etiology)
• Incidence
• Japan (epidemiology)
• Liver (physiopathology)
• Male
• Middle Aged
• Predictive Value of Tests
• Retrospective Studies
• Survival Analysis
• Transplantation, Homologous
• Young Adult