Inflammatory Markers in Patients after Hematopoietic Stem Cell Transplantation
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REVIEW
Inflammatory Markers in Patients after Hematopoietic Stem Cell Transplantation Camilla Sjøqvist • Emilian Snarski
Received: 19 June 2012 / Accepted: 25 March 2013 / Published online: 7 April 2013 Ó L. Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland 2013
Abstract Infections are one of the most common complications after hematopoietic stem cell transplantation (HSCT). Diagnosis is established by analysis of clinical symptoms and results of diagnostic tests such as biochemical panels, microbiological cultures, and visual diagnostics. As the microbiological cultures yield positive results in only some patients and visual diagnostics might miss the infectious source, the diagnosis and proper treatment often depends on clinical assessment supported by laboratory test results. The most commonly used makers of inflammation include C-reactive protein and procalcitonin. However, these tests have serious limitations when used in patients after HSCT. The drugs used in conditioning, neutropenia, and graft-versus-host disease might influence the results of the tests and misguide the physician. In this review, we summarize the current knowledge on profiles of expression of basic markers of inflammation used in clinical practice in patients after HSCT. Keywords C-reactive protein Procalcitonin Hematopoietic stem cell transplantation Infection Abbreviations aGvHD Acute graft-versus-host disease ATG Antithymocyte globulin BMT Bone marrow transplantation CRP C-reactive protein FUO Fever of unknown origin GvHD Graft-versus-host disease HSCT Hematopoietic stem cell transplantation C. Sjøqvist E. Snarski (&) Department of Hematology, Oncology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland e-mail: [email protected]
MTC PCT TBI
Major transplant-related complication Procalcitonin Total body irradiation
Introduction Hematopoietic stem cell transplantation (HSCT) allows successful treatment of many hematologic malignancies and nonmalignant disorders. The curative potential of this procedure and survival of the patients is limited by infection, the recurrence of the disease and by graft-versus-host diseases (GvHD) in allogeneic transplant recipients. The infection risk is elevated as a result of substantial alteration of the function of the immune system, caused by prior treatment and transplantation. Moreover, the complications of the transplantation such as GvHD and the resulting treatment might lead to further immunosuppression and increase the risk of severe infections. An early detection and treatment of infection is essential to decrease morbidity and mortality in severely immunocompromised patients. Defining the pathogenesis of transplant-related complications and differentiating them is often problematic due to unspecific clinical signs and symptoms during their presentation. The blood cultures might be negative even during severe sepsis and visual diagnostics will not always be of use. However, monitoring the serum levels of infection biomarkers before and aft
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