Impact of Prealbumin and Absolute Lymphocyte Count on Outcomes of Allogeneic HSCT

By Dustin Samples - February 16, 2023

Many factors are indicated to affect graft-versus-host disease (GVHD) occurrence after allogeneic hematopoietic stem cell transplantation (HSCT). One that has been investigated is absolute lymphocyte count (ALC), the product of the percentage of lymphocytes and the total number of white blood cells.

In a single-center study, researchers at the Allegheny Health Network Cancer Institute assessed the effect of ALC on engraftment, acute GVHD, and mortality. They also considered pretransplant prealbumin levels (prealbumin is an indicator of nutritional status and helps carry proteins through the blood).

The team looked at the outcomes of 159 patients who underwent allogeneic HSCT from 2015-2021. The outcomes correlated with nutritional status using prealbumin levels of 17 mg/dl as the normal level. ALC was assessed on the day of neutrophil engraftment, with 0.5-3.5 k/mcL considered the normal range. The assessed outcomes included days to achieve neutrophil engraftment, incidence and severity of acute GVHD, relapse, non-relapse mortality (NRM), and overall survival (OS).

Most patients in this study had normal prealbumin levels but abnormal ALC levels (n=138, 153, respectively).

“Low ALC was associated with increased risk of acute-GVHD, NRM mortality and poor overall survival,” reported the research team.

Regarding prealbumin levels, which is a measure that can be “optimized prior to HSCT,” the team found increased NRM and decreased OS.

The team concluded, “prospective studies should be conducted to measure [total nutrition and prealbumin’s] impact on HSCT outcomes.”

Shah S, Rai M, Sadashiv S, et al. Impact of Absolute Lymphocyte Count (ALC) and Pre-Transplant Prealbumin Level on Engraftment, Acute Graft Versus Host Disease (GVHD) and Mortality Following Allogeneic Hematopoietic Cell Transplantation: A Single Institution Experience. Abstract #366. Presented at the 2023 Tandem Meetings of ASTCT and CIBMTR; February 15-19, 2023; Orlando, FL.

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