Serum Albumin Level < 32 g/l on Day 30 Can Predicts Higher Risk of Non-Relapse Mortality in Acute Lymphoblastic Leukemia Following Allogeneic Stem Cell Transplantation
Notice bibliographique
Résumé
Introduction: It is extremely significant issue to predict hematopoietic stem cell transplant (HSCT) outcomes using a biomarker. In this study, we attempted to evaluate the impact of post-transplant serum albumin on outcomes in patients with acute lymphoblastic leukemia (ALL). Methods: 123 patients with ALL receiving HSCTs between 1999 and 2012 at our center were evaluated for post-transplant serum albumin levels and their correlation with transplant's outcome. The level of serum albumin was retrospectively retrieved in certain time point ± 3 days for following periods: 1 month pre HSCT and then weekly after transplantation for first 3 months. 100 patients had available serum albumin levels. The ROC analyses were used to determine the most statistically significant cutoff level of serum albumin level correlating with NRM at 1 year. The ROC analysis suggested the level of 32 g/l at 4 weeks post HSCT as the best cutoff level for further analysis. Thus patients were stratified into low versus high albumin level group according to that cutoff level. Results: Median age for all patients is 37 (range 17-61), 35% were female and related donors were 57%. Matched donors were 83%. 71% were in 1st complete remission. 37% were Philadelphia chromosome positive. GVHD prophylaxis was CSA/MTX 60%, CSA/MMF 22%. Conditioning regimen was myeloablative in 95%. 61% received peripheral blood stem cells. With a median follow-up among survivors of 60 months (range 21-100), 61% patients showed albumin level ³ 32g/l at day 30 while 39% showed dropped albumin level <32 g/l at day 30. The OS rate at 2 years was 61% in high albumin group versus 23% in low albumin group (p < 0.001). The NRM rate was 62% in high albumin group versus 17% in low albumin group (p < 0.001). However, no difference of relapse incidence was noted between the two groups. The cumulative incidence of overall acute GVHD, grades 2/4, grades 3/4 at day 120 and overall chronic GVHD at 2 years was 67%, 59%, 16% and 45% in high albumin group versus 72%, 70%, 49% and 39% in low albumin group, suggesting higher incidence of grade 3/4 acute GVHD in low albumin group vs high. In multivariate analysis, serum albumin level < 32 g/l at 4 weeks was confirmed as an independent adverse risk factor for NRM (p=0.04, HR 2.81) together with acute GVHD grades 3/4 (p 0.01, HR 3.79) and chronic GVHD (p²0.001, HR 0.21). For OS, albumin level was not confirmed as an independent risk factor, but acute GVHD grade 3/4 (p< 0.001, HR 3.36) and chronic GVHD (p <0.001, HR 0.008) were found to be independent factors. For relapse chronic GVHD grade 3-4 was the only independent prognostic factor (p <0.001, HR 0.27). Conclusion: The present study suggested that 1) serum albumin level less than 32 g/l at day 30 can predicts higher risk of non-relapse mortality and 2) dropped serum albumin might be affected by in part the occurrence of severe acute GVHD, and by independent mechanism of gut GVHD. Further study is strongly warranted to confirm the prognostic role of serum albumin level on transplant outcomes in a prospectively designed study. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».