Hyperglycemia During the Neutropenic Period Is Associated With a Poor Outcome in Patients Undergoing Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

While the results suggested an association between the degree of hyperglycemia during neutropenia and an increased risk of posttransplant complications and NRM, the possibility that intensive glucose control improves the outcome after HSCT can only be confirmed in a prospective randomized trial.

Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia

“…There have been substantial improvements in HLA typing over the period of 1997-2008, with more accuracy in defining HLA haplotypes at highresolution. 26,27 In addition to high-resolution donor-recipient HLA matching, the more frequent use of tacrolimus, [28][29][30] the prompt initiation of treatment after a more thorough examination to diagnose GVHD, 31 and supportive care and nutritional management 32 may have contributed to the reduced risk of GVHD-related mortality as did in allo-HCT in remission. Alternatively, the unique HLA epidemiological genetics of Japanese patients may have affected the results.…”

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

“…Our earlier study demonstrated that glucose values above 200 mg/dL were associated with twofold or more increase in NRM, compared with BG values between 101 and 150 mg/dL. 24 Similarly, Fuji et al 25 demonstrated an association between hyperglycemia and increased risk of organ dysfunction, grade II-IV acute GvHD and NRM in adult patients treated by myeloablative allogeneic HCT, and Gebremedhin et al 26 demonstrated that severe hyperglycemia immediately after allogeneic HCT was predictive of acute GvHD. There is, therefore, interest in improving glycemic control in the hope of improving transplant outcome.…”

Decreased insulin secretion in patients receiving tacrolimus as GVHD prophylaxis after allogeneic hematopoietic SCT

“…In contrast, hyperglycemia was associated with a higher risk of non-relapse mortality after allogeneic HSCT. 1,3 In our earlier study, patients with severe hyperglycemia had a significantly higher incidence of acute GVHD compared with normoglycemic patients. 3 Therefore, it is possible that hyperglycemia related to the use of TAC could offset the potential benefit of TAC, and drugs that increase insulin secretion, including the glucagon-like peptide-1 analog, may reverse the suppression of the insulin level.…”

“…1,3 In our earlier study, patients with severe hyperglycemia had a significantly higher incidence of acute GVHD compared with normoglycemic patients. 3 Therefore, it is possible that hyperglycemia related to the use of TAC could offset the potential benefit of TAC, and drugs that increase insulin secretion, including the glucagon-like peptide-1 analog, may reverse the suppression of the insulin level. 7 Whether intensive glucose control could reduce the risk of acute Table 1 Pretransplant and posttransplant glycemic status…”

“…[1][2][3] A characteristic feature of this field is the use of calcineurin inhibitors, including tacrolimus (TAC), which may cause hyperglycemia as suggested in organ transplant settings, possibly by decreasing insulin secretion. 4 To evaluate this possibility, we serially monitored fasting glucose levels and serum immunoreactive insulin, and calculated homeostasis model assessment (HOMA)-IR and HOMA-b with the HOMA model 5 as recommended by Wallace et al 6 HOMA-IR reflects insulin resistance and HOMA-b reflects the insulin secretion status.…”