Evaluating the Pre-transplant Serum Levels of C-reactive Protein as a Prognostic Factor for Allogeneic Hematopoietic Stem Cell Transplantation Outcomes

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a potentially curative therapeutic approach for hematological malignancies. It has been suggested that pre-transplant C-reactive protein (CRP) assessment may have prognostic value in Allo-HSCT recipients. Objectives: This study aimed to investigate the determinants influencing pre-transplant CRP levels in patients undergoing Allo-HSCT and to evaluate the association between this biomarker and transplantation outcomes, as well as the relationship between certain risk factors and CRP levels. Methods: A total of 201 patients who underwent Allo-HSCT were selected for this retrospective study. The predictive value of CRP for acute graft-versus-host disease (aGVHD) and overall survival (OS) was evaluated using receiver-operating characteristic (ROC) analysis. The associations between pre-transplant serum CRP levels and transplantation outcomes — including aGVHD incidence and OS — as well as between specific risk factors and CRP levels, were analyzed using logistic and Cox regression models. Results: Despite the poor prognostic power of the determined cut-off [area under curve (AUC): 59.1% (43.6 - 74.5) for aGVHD; AUC: 57.2% (47.5 - 66.8) for OS], our findings indicate that elevated pre-transplant CRP levels are significantly associated with increased aGVHD incidence [adjusted odds ratio (AOR): 1.86, 95% confidence interval (CI, 1.44 - 9.18), P = 0.05] and a non-significant trend toward worse OS [adjusted hazard ratio (AHR): 2.74, 95% CI (1.02 - 7.38), P = 0.11]. Additionally, a statistically significant association was observed between elevated CRP levels and administration of antithymocyte globulin (ATG) as part of the prophylaxis regimen. Conclusions: The results suggest that pre-transplant CRP levels could potentially serve as a prognostic biomarker for predicting higher aGVHD incidence and inferior OS. The Allo-HSCT remains an established therapeutic modality in hematological malignancies.