Serum cholinesterase is an early and sensitive marker of graft-versus host-disease (GVHD) and transplant-related mortality (TRM)

Abstract

Summary:Serum cholinesterase (CHE) has been reported to be a significant indicator of liver function and prognosis in patients with cirrhosis. On the other hand, liver complications are frequent following allogeneic stem cell transplantation (HSCT). We therefore tested whether CHE was predictive of graft-versus-host disease and outcome in HSCT recipients. We studied 689 patients receiving a HSCT from an HLA-identical sibling (SIB) (n = 511), an alternative donor (n = 173) or a syngeneic twin (n = 5). Acute graft-versus-host disease (GVHD) was scored as 0-I, II, III-IV in 325 (47%), 279 (41%), and 85 patients (12%) respectively; 190 (28%) patients died of transplant-related complications (TRM). On day −7 the median CHE serum level was comparable in patients who either survived or died of TRM (5900 IU/l). On day 0, serum CHE levels were respectively 2310 and 2120 IU/l (P = NS) indicating the impact of the conditioning regimen. On day +7 after HSCT, the median level for surviving patients was 2598 IU/l vs 2309 IU/l for patients who subsequently died (P = 0.0002), on day +21 CHE levels were respectively 3348 vs 2528 IU/l (P Ͻ 0.00001), on day +50, 3575 vs 2358 IU/l (P Ͻ 0.00001) and on day +100 4193 vs 2729 IU/l (P Ͻ 0.00001). CHE levels on day +50 strongly correlated with aGVHD (3803 vs 3070 vs 1933 IU/l for patients with GVHD grade 0-I, II, and III-IV, respectively (P Ͻ 0.00001) and relapse (3569 for patients relapsing vs 3115 IU/l for patients not relapsing, P = 0.0006). In conclusion, (1) serum cholinesterase is a simple and reliable marker of acute GVHD and transplant-related complications; and (2) high CHE levels on day +50 predict relapse. If confirmed, the latter patients may be elegible for early reduction of immunosuppressive therapy. Bone Marrow Transplantation (2001) 28, 1041-1045.

Successful engraftment and stable full donor chimerism after myeloablation with thiotepa, fludarabine, and melphalan and CD34‐selected peripheral allogeneic stem cell transplantation in hemophagocytic lymphohistiocytosis

“…There is nothing to show that this combination is superior to other myeloablative regimens in terms of disease eradication or long-term engraftment. On the other hand, busulfan-based conditioning carries a high risk of severe transplant-related hepatic morbidity and mortality due to veno-occlusive disease [8][9][10]. In addition, the typical liver involvement at diagnosis of HLH and at HSCT, in cases transplanted with active disease despite prior chemotherapy, may exacerbate the risk of liver toxicity [11,12].…”

Progenitor cells trapped in marrow filters can reduce GvHD and transplant mortality

“…Of course, the two groups are consecutive and this should also be kept in mind when looking at the results. Recovery of platelet and lymphocyte counts was significantly enhanced in filterrecovered patients and this may be explained by the greater number of early haemopoietic progenitors in filter-recovered grafts; we also saw less grade II-IV acute GVHD, higher cholinesterase levels, 13 and higher total protein and serum albumin levels. Why should filter-recovered patients have less acute GvHD?…”

Serum cholinesterase: A predictive biomarker of hepatic reserves in chronic hepatitis D

“…Cholinesterase levels have been assessed to predict survival in patients with Parenchymal cirrhosis[ 14 ], predict outcome in graft- vs -host disease[ 15 ], distinguish between liver disease and non-liver disease aberration in liver function tests[ 16 ] and differentiate cirrhosis from non-cirrhosis[ 17 ]. Serum cholinesterase levels have also been found to correlate with CTP Class[ 18 , 19 ].…”