Diagnostic and Prognostic Value of Biochemical Markers of Infectious Complications of High-Dose Therapy with Autologous Hematopoietic Stem Cell Transplantation in Malignant Lymphoproliferative Diseases

Abstract

Aim. To evaluate diagnostic and prognostic value of C-reactive protein (CRP), procalcitonin (PCT) and presepsin (PSP) in patients with malignant lymphoproliferative disorders after a high-dose chemotherapy and auto-HSCT. Methods. 28 patients were included in the study (20 women and 8 men; 12 of them with Hodgkin’s lymphoma, 6 with non-Hodgkin’s lymphomas, and 10 with multiple myeloma). The median age was 40 years (23-66 years). The conditioning regimens were CBV, BEAM or melphalan 200 mg/m². PSP, PCT and CRP levels were evaluated on the day of admission (DA), D+1, D+3, D+7 and on the day of discharge (DD). Depending on the presence of infectious complications, the patients were divided into 2 groups: group 1 - patients without complications (n = 12), group 2 - patients with complications (n = 16). In group 2 there were 15 patients with febrile neutropenia (FN) and 1 with sepsis. Results. The median (range) of FN development was 5.5 days. Median CRP level on the DA and the DD in group 1 was 2.25 mg/l (0.6-20.4) and 14.85 mg/l (3.7-50), respectively (p = 0.001), while in group 2 it was 3.2 mg/l (0.2-53) and 19.7 mg/l (5.1-152.2), respectively (p = 0.025). However, CRP did not significantly differ between groups 1 and 2 at any point of analysis. The study also demonstrated a significant increase in the PCT levels in both groups after allo-HSCT. Median PCT level on the DA and the DD in group 1 was 0.023 ng/ ml (0.02-0.112) and 0.07 ng/mL (0.02-0.356), respectively (p = 0.04), and in group 2 - 0.039 ng/ml (0.02-0.158) and 0.106 ng/mL (0.045-3.67), respectively (p = 0.001). Comparison of PCT levels on study days demonstrated no significant difference between groups. On the DA the median PSP level in group 1 was 166.5 pg/ml (77.2-476), on the DD it was 199 pg/ml (90-298) (p = 0.78). Median PSP levels in group 2 on the DA (129 pg/ml, range 84.2-501) and also on the DD (288.5 pg/ml, range 83.4-1345) were significantly different (p = 0.03). In the comparative analysis of PSP in groups 1 and 2, there were no significant differences on the DA and on the D+1. Significant difference in PSP levels between the analyzed groups was on the D+3, D+7 and on the DA. Conclusion. The preliminary data showed that PSP is the most sensitive marker of infectious complications in patients with lymphoproliferative diseases after auto-HSCT.