C-reactive protein levels before reduced-intensity conditioning predict outcome after allogeneic stem cell transplantation

The prognostic value of CRP levels before conditioning for allogeneic stem-cell transplantation (ASCT) was evaluated. Reduced-intensity conditioning (RIC) was given to 205 patients and conventional myeloablative conditioning (MAC) to 299 patients. Most patients had an HLA-compatible related or unrelated donor. There were 287 males and 216 females, median age 36 (1-69) years. Most patients received peripheral blood stem cells. Increased CRP levels (> 10 mg/L) were detected in 129 patients (26%). Overall survival (OS) and transplant-related mortality (TRM) were worse for RIC patients with elevated CRP (67 vs. 43%, p = 0.005, and 16 vs. 30%, p = 0.036) while no difference was seen in MAC patients. An infection at the start of conditioning was seen in 27 RIC patients. We identified a subgroup of patients with an infection and elevated CRP (n = 16) and these patients had the worst outcome. In multivariate analysis, both infection and elevated CRP was the strongest factor associated with OS (HR 3.27, p < 0.001) and TRM (HR 4.35, p < 0.001). No correlation between any outcome variable and CRP was seen in MAC-treated patients. CRP may be a good prognostic factor for outcome after RIC and ASCT. It should be analyzed before conditioning, especially in patients with coexisting infection since patients with increased CRP and infection seem to have a very poor outcome after ASCT.