J Korean Med Sci.  2009 Aug;24(4):555-560. 10.3346/jkms.2009.24.4.555.

Influence of Lactate Dehydrogenase and Cyclosporine A Level on the Incidence of Acute Graft-versus-host Disease After Allogeneic Stem Cell Transplantation

• Song MK
• Chung JS
• Seol YM
• Kwon BR
• Shin HJ
• Choi YJ
• Cho GJ

• KMID: 1779183
• DOI: http://doi.org/10.3346/jkms.2009.24.4.555

Abstract

Previous reports have suggested that a high serum cyclosporine A (CsA) level could result in a lower incidence of acute-graft-versus-host disease (aGVHD). An elevated serum lactate dehydrogenase (LDH) level has been reported to be an adverse predictor of outcome in stem cell transplantation (SCT) for acute myeloid leukemia. In this study, we retrospectively analyzed the records of 24 patients who received allogeneic SCT from an HLA-matched sibling donor for acute and chronic myelogenous leukemia. Univariate analysis showed that two factors (the serum CsA level at the third week after SCT and the LDH level at the third week after SCT) were significantly associated with the incidence of aGVHD among several variables (age, sex, stem cell source, cell dose, C-reactive protein, absolute lymphocyte count, conditioning regimens, and time to engraftment). A higher serum level of CsA and lower serum LDH level at the third week after SCT were associated with a lower incidence of aGVHD (P=0.015, 0.030). In multivariate analysis, the serum CsA level (hazard ratio [HR], 0.12; 95% confidence interval [CI], 0.022-0.652, P=0.0014) and serum LDH level (HR, 6.59; 95% CI, 1.197-36.316, P=0.030) at the third week after SCT were found to be independent factors that were significantly associated with the development of aGVHD. We conclude that a high CsA level and low LDH level might predict a low cumulative incidence of aGVHD after allogeneic transplantation from a matched sibling donor.

Keyword

Leukemia, Myeloid, Acute; Cyclosporine; Graft vs Host Disease

MeSH Terms

Acute Disease
Adult
Cyclosporine/*blood
Female
Graft vs Host Disease/*epidemiology/etiology
Humans
L-Lactate Dehydrogenase/*blood
Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy
Leukemia, Myeloid, Acute/therapy
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Retrospective Studies
Risk Factors
*Stem Cell Transplantation
Transplantation, Homologous

Figure

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  Fig. 1 The cumulative incidence of aGVHD of the two serum CsA groups at the third week after transplantation. A higher CsA level was associated with a lower incidence of aGVHD above grade II (P=0.0004). aGVHD, acute graft-versus-host disease; HCsA, higher cyclosporine A; LCsA, lower cyclosporine A.

• 

  Fig. 2 The cumulative incidence of aGVHD of the two serum LDH groups at the third week after transplantation. A lower LDH level was associated with a lower incidence of aGVHD above grade II (P=0.0026). aGVHD, acute graft-versus-host disease; HLDH, higher lactate dehydrogenase; LLDH, lower lactate dehydrogenase.

• 

  Fig. 3 The cumulative incidence of aGVHD of four groups (HCsA+LLDH, HCsA+HLDH, LCsA+LLDH, and LCsA+HLDH group) at the third week after transplantation. The HCsA+LLDH group showed significantly better results than the other groups (P=0.0016). aGVHD, acute graft-versus-host disease; HCsA, higher cyclosporine A; LCsA, lower cyclosporine A; HLDH, higher lactate dehydrogenase; LCsA, lower cyclosporine A.

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