Summary:Urinary trypsin inhibitor has attracted attention as an index of the systemic inflammatory response syndrome. In this study, the urine concentration of trypsin inhibitor was measured to compare the immunological insult of conventional chemotherapy and conditioning chemotherapy for bone marrow transplantation. We also investigated whether urinary trypsin inhibitor was a useful index of the complications and outcome of bone marrow transplantation. Urinary trypsin inhibitor concentration was determined before chemotherapy, on the day after finishing chemotherapy (day 0 of transplantation), and during recovery of the white cell count, in 17 patients ( seven receiving conventional chemotherapy and 10 receiving conditioning for bone marrow transplantation). Urinary trypsin inhibitor concentrations were significantly higher after conditioning for bone marrow transplantation than after conventional chemotherapy (P Ͻ 0.001), indicating that conditioning was more invasive. After bone marrow transplantation, the incidence of severe complications and the mortality rate were higher in patients whose urinary trypsin inhibitor concentrations rose during recovery of the white cell count. Comparison of urinary trypsin inhibitor concentrations suggested that conditioning for bone marrow transplantation was more invasive than conventional chemotherapy. This study also suggested that the urine concentration of trypsin inhibitor could be useful for predicting the risk of complications and outcome of bone marrow transplantation. Bone Marrow Transplantation (2001) 27, 195-199. Keywords: allogeneic bone marrow transplantation; systemic inflammatory response syndrome; urinary trypsin inhibitor; interleukin-6; C-reactive protein Bone marrow transplantation (BMT) is not only an established therapy for hematological malignancies, but also for Recently, we investigated the relationship between cytokines and vascular endothelial cell dysfunction after BMT and advocated the concept that complications of BMT are collectively caused by the systemic inflammatory response syndrome (SIRS).1-5 The urine concentration of trypsin inhibitor (TI) is known to be very closely associated with the extent of surgical invasion and also reflects the severity of SIRS. 6 In the present study, the usefulness of urinary TI as a predictor of complications and the outcome of BMT was assessed by measuring the concentrations of this marker before and after transplantation.
Materials and methods
SubjectsThe subjects were 10 consecutive patients who underwent allogeneic BMT from March 1999 to December 1999 and seven consecutive patients who were treated by conventional chemotherapy from September 1999 to December 1999, at our institution. Tables 1 and 2 show the age, gender, underlying disease, and disease stage. These also show the donor, conditioning regimen, and GVHD prophylaxis for BMT patients, as well as the chemotherapy regimen for those given conventional chemotherapy. The basic conditioning regimen was busulfan (BU), cyclophosphamide (CY), and total bo...