The MDS Beacon™

Results of a recent study suggest that serum albumin, a protein in blood, may be a good factor to determine the prognoses of acute myeloid leukemia and myelodysplastic syndromes patients who have received an allogeneic stem cell transplant.

Stem cell transplantation is the only known cure for myelodysplastic syndromes (MDS). When patients undergo an allogeneic stem cell transplant, they receive healthy stem cells from a donor (For more information about stem cell transplantation, please see the related Beacon article).

However, not all patients are suitable for transplants, and more than 20 percent of recipients die during the first year after the transplant. Patients who receive a stem cell transplant are therefore often required to stay near their transplant center for at least 90 days after the procedure for monitoring purposes.

The researchers aimed to identify factors that would help determine which patients have a poorer prognosis during that time. Patients with poor prognoses could then be treated earlier or more aggressively after the transplant to improve survival.

The researchers retrospectively analyzed the survival data for 163 acute myeloid leukemia and MDS patients who received allogeneic stem cell transplants at the Moffitt Cancer Center from September 2000 to July 2007.

The researchers found that 90 days after a stem cell transplant, low serum albumin levels, also known as hypoalbuminemia, were associated with poorer non-relapse mortality and overall survival.

Serum albumin is the most common protein in the liquid part of human blood. It maintains the pressure in the circulatory system and helps to transport drugs, hormones, and other substances through the blood stream. Normal serum albumin levels generally indicate healthiness.

The median survival time after transplant was 2.2 years. Of the 163 patients studied, 22 relapsed by 90 days after the transplant. The average serum albumin level for patients who relapsed was 3.32 g/dL. The patients who did not relapse had an average serum albumin level of 3.54 g/dL.

Having serum albumin levels of 3.5 g/dL or less and developing pneumonia were associated with a higher risk of death that was not associated with relapse. Male patients who received stem cells from female donors were also at a higher risk for non-relapse mortality than female patients with male donors.

For overall survival, serum albumin levels of 3.5 g/dL or lower, worsening kidney function, being more severely affected by the disease, and developing pneumonia were associated with worse overall survival.

Improved survival was associated with receiving stem cells from a female donor.

The researchers pointed out that larger studies are necessary to confirm their findings.

They suggested prospective studies be conducted to evaluate serum albumin levels at earlier points after stem cell transplantation since it may offer the opportunity for earlier intervention.

For more information, please see the study in Biology of Blood and Marrow Transplantation (abstract).