Value of the pretransplant evaluation in predicting toxic day-100 mortality among blood stem-cell and bone marrow transplant recipients

Purpose: To determine the valve of pretransplant studies in predicting day 100 nonrelapse toxic mortality following high-dose therapy. Patients and Methods: A retrospective review of 383 consecutive hematopoiet ic stem-cell transplants was performed with attention to toxic mortality an d pretransplant factors. Univariate log-rank analysis wets used to yield th e most significant cut-off values for individual factors. Multivariate anal ysis using Cox proportional hazards regression determined factors independe ntly predictive of early toxic death. Results: Nonrelapse toxic mortality before day 100 occurred in 23 of 383 (6 .0%) transplant recipients. Factors associated with an increased risk of to xic death by univariate analysis included forced expiratory volume in 1 sec ond (FEV1) less than 78% of predicted (P = .0002), allogeneic versus autolo gous transplant (P = .0003), diffusion capacity of carbon monoxide less tha n 52% of predicted (P = .002), serum creatinine concentration greater than 1.1 mg/dL (P = .003), Eastern Cooperative Oncology Group performance status greater than O (P = .006), preparative regimen containing total-body irrad iation versus chemotherapy alone (P = .006), marrow verses blood stem cell (P = .01), serum ALT greater than 50 IU/L (P = .02), diagnosis of hematolog ic disorder versus solid tumor (P = .06), serum bilirubin level greater tha n 1.1 mg/dL (P = .08), left ventricular ejection fraction (P = .09), and gr owth factor use (P = .09). In the multivariate model, transplant type (rela tive risk, 4.2), FEV1 (relative risk, 4.5), performance status (relative ri sk, 3.7), serum creatinine (relative risk, 3.8), and serum bilirubin (relat ive risk, 3.7) were found to be independent predictors of early toxic morta lity. Conclusion: The pretransplant evaluation is a useful tool to identify patie nts at risk for early toxic mortality following high-dose therapy. (C) 1998 by American Society of Clinical Oncology.