Hyperbilirubinemia in the early phase after allogeneic HSCT: Prognostic significance of the alkaline phosphatase/total bilirubin ratio

M. Ashizawa, K. Oshima, H. Wada, Y. Ishihara, K. Kawamura, K. Sakamoto, M. Sato, K. Terasako, T. Machishima, S. Kimura, M. Kikuchi, H. Nakasone, S. Okuda, S. Kako, J. Kanda, Rie Yamazaki, A. Tanihara, J. Nishida, Y. Kanda

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Hyperbilirubinemia in the early phase after allogeneic hematopoietic SCT (HSCT) is due to various causes. One of the most important causes of hyperbilirubinemia is veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS). However, the prognosis of patients who are clinically diagnosed as SOS varies. We retrospectively evaluated 82 patients who underwent their first allogeneic HSCT. GVHD prophylaxis was a combination of short-term MTX and CsA (n=77) or tacrolimus (n=5). Thirty-three patients developed hyperbilirubinemia, with a bilirubin level of at least 2 mg/dL, within 20 days after HSCT. Of these patients, 24 were diagnosed as VOD/SOS using the modified Seattle criteria. Twenty-six recovered to a bilirubin level of <2 mg/dL. We focused on the serum alkaline phosphatase/total bilirubin ratio (ALP/TB) at the onset of hyperbilirubinemia and found that it significantly predicted the recovery from hyperbilirubinemia. OS was significantly higher in patients with a lower ALP/TB ratio (P=0.00056). In addition, a lower ALP/TB ratio was associated with better survival even in patients who were clinically diagnosed as SOS (P<0.001). The ALP/TB ratio at the onset of hyperbilirubinemia may be a useful predictor for the prognosis of hyperbilirubinemia and SOS early after HSCT.

Original languageEnglish
Pages (from-to)94-98
Number of pages5
JournalBone Marrow Transplantation
Volume48
Issue number1
DOIs
Publication statusPublished - 2013 Jan 1
Externally publishedYes

Fingerprint

Hyperbilirubinemia
Bilirubin
Alkaline Phosphatase
Tacrolimus
Survival
Serum

Keywords

  • Alkaline phosphatase
  • HSCT
  • Hyperbilirubinemia
  • Total bilirubin

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Hyperbilirubinemia in the early phase after allogeneic HSCT : Prognostic significance of the alkaline phosphatase/total bilirubin ratio. / Ashizawa, M.; Oshima, K.; Wada, H.; Ishihara, Y.; Kawamura, K.; Sakamoto, K.; Sato, M.; Terasako, K.; Machishima, T.; Kimura, S.; Kikuchi, M.; Nakasone, H.; Okuda, S.; Kako, S.; Kanda, J.; Yamazaki, Rie; Tanihara, A.; Nishida, J.; Kanda, Y.

In: Bone Marrow Transplantation, Vol. 48, No. 1, 01.01.2013, p. 94-98.

Research output: Contribution to journalArticle

Ashizawa, M, Oshima, K, Wada, H, Ishihara, Y, Kawamura, K, Sakamoto, K, Sato, M, Terasako, K, Machishima, T, Kimura, S, Kikuchi, M, Nakasone, H, Okuda, S, Kako, S, Kanda, J, Yamazaki, R, Tanihara, A, Nishida, J & Kanda, Y 2013, 'Hyperbilirubinemia in the early phase after allogeneic HSCT: Prognostic significance of the alkaline phosphatase/total bilirubin ratio', Bone Marrow Transplantation, vol. 48, no. 1, pp. 94-98. https://doi.org/10.1038/bmt.2012.130
Ashizawa, M. ; Oshima, K. ; Wada, H. ; Ishihara, Y. ; Kawamura, K. ; Sakamoto, K. ; Sato, M. ; Terasako, K. ; Machishima, T. ; Kimura, S. ; Kikuchi, M. ; Nakasone, H. ; Okuda, S. ; Kako, S. ; Kanda, J. ; Yamazaki, Rie ; Tanihara, A. ; Nishida, J. ; Kanda, Y. / Hyperbilirubinemia in the early phase after allogeneic HSCT : Prognostic significance of the alkaline phosphatase/total bilirubin ratio. In: Bone Marrow Transplantation. 2013 ; Vol. 48, No. 1. pp. 94-98.
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AU - Nakasone, H.

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AU - Kako, S.

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AB - Hyperbilirubinemia in the early phase after allogeneic hematopoietic SCT (HSCT) is due to various causes. One of the most important causes of hyperbilirubinemia is veno-occlusive disease/sinusoidal obstructive syndrome (VOD/SOS). However, the prognosis of patients who are clinically diagnosed as SOS varies. We retrospectively evaluated 82 patients who underwent their first allogeneic HSCT. GVHD prophylaxis was a combination of short-term MTX and CsA (n=77) or tacrolimus (n=5). Thirty-three patients developed hyperbilirubinemia, with a bilirubin level of at least 2 mg/dL, within 20 days after HSCT. Of these patients, 24 were diagnosed as VOD/SOS using the modified Seattle criteria. Twenty-six recovered to a bilirubin level of <2 mg/dL. We focused on the serum alkaline phosphatase/total bilirubin ratio (ALP/TB) at the onset of hyperbilirubinemia and found that it significantly predicted the recovery from hyperbilirubinemia. OS was significantly higher in patients with a lower ALP/TB ratio (P=0.00056). In addition, a lower ALP/TB ratio was associated with better survival even in patients who were clinically diagnosed as SOS (P<0.001). The ALP/TB ratio at the onset of hyperbilirubinemia may be a useful predictor for the prognosis of hyperbilirubinemia and SOS early after HSCT.

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