Associations of biomarkers with potential confounding and multivariable analysis.
tumor necrosis, infections, CRS, GVHD, Infections, weight gain, TMA
INFILTRATION, TUMOR NECROSIS, PLATELET REFRACTORINESS, FLUID RETENTION, THROMBOTIC MICROANGIOPATHY, RESPIRATORY FAILURE, INFECTIONS, INFECTIONS, REGRESSION, GVHD, PATHOGENESIS, COMPLICATIONS
Currently, the diagnosis of SOS includes clinical characteristics and measurement of bilirubin (Considering that several other potential complications could occur during the first 35 days, such as cytokine storm (CRS), even if subclinical; thrombotic microangiopathy (TMA), which is typically accompanied by endothelial damage like SOS; IPS; GVHD; and infections, we examined the correlation of the day 3 SOS biomarkers with these 4 potential early complications. Demographics for these other complications are shown in As we did not observe any clinical CRS, we used 2 key inflammatory cytokines after HCT (interleukin 6 [IL-6] and tumor necrosis factor receptor 1 [TNFR1]) as surrogates for subclinical CRS. Both day 3 and day 7 TNFR1 levels displayed significant differences between patients with SOS versus without, but IL-6 was not different between groups (Since TMA shares certain features with SOS, including platelet refractoriness and fluid retention (SOS can cause rapid weight gain, resulting in respiratory failure, which is also a feature of IPS. Therefore, we examined biomarker levels on day 3 for an association with IPS. Only 2 patients had IPS, 1 in the SOS group and 1 in the no-SOS group, and only L-ficolin was associated with IPS (Given that SOS pathogenesis is a combination of endothelial damage and leukocyte infiltration due to alloreactivity, we investigated biomarker association with overall GVHD grades. Two (20%) patients developed GVHD in the SOS group and 12 (19.3%) developed GVHD in the no-SOS group (Infections commonly occur after HCT; however, there was no difference between patients with SOS versus those without in the rate of infections of grade 3 or higher (We next calculated associations between high and low biomarkers and SOS incidence in univariate and multivariate Cox proportional hazards regression models (