The relationship between c-reactive protein and engrafment after autologous hematopoietic stem cell transplantation in patients with multiple myeloma

Objective: Autologous hematopoietic stem cell transplantation (HSCT) is the most important treatment option in eligible patients with multiple myeloma after induction therapy. Various infections and acute phase reactant elevation can be detected after HSCT. In our clinic, even if there were no infectious signs and symptoms in patients, we observed that C-Reactive Protein (CRP) values could increase before the neutrophil engraftment. So, we aimed to investigate the relationship between the neutrophil engraftment and the CRP elevation in this study. Materials and Methods: 109 patients with OKHN due to multiple myeloma at the Dokuz Eylul University Hospital Stem Cell Transplant Unit between January 2014 and December 2019 were examined. Demographic features, the highest CRP value achieved before neutrophil engraftment (CRP peak value), infectious findings if any and neutrophil engraftment day were recorded. Infections in the preengrafman period has been categorized as fever, pneumonia, urinary tract infection, abdominal / gastrointestinal tract infections, catheter-related infections and bacteriemia. Results: 109 patients were examined (44 females, 65 males) and it was found that the median neutrophil engraftment day was the 11th day, the median CRP peak value was 135 mg / L, and the median CRP peak value was reached 3 days before neutrophil engraftment. When patients with infections were examined separately, we detected neutrophenic fever in 60 patients (55%), pneumonia in 9 patients (8,3%), urinary tract infection in 7 patients (6,4%), abdominal/gastrointestinal tract infections in 9 patients (8,3%), catheter-related infection in 32 patients (29,4%) and bacteriemia in 23 patients (21,1%). Median CRP peak value of patients with infections (n:83, 75,1%) and without infections (n:26, 23,9%) was 148 mg/L and 87 mg/L, separately (p:<0,01). The CRP peak value of patients with no infection was found to be significantly higher compared to the normal accepted CRP value (5 mg / L) (p: <0.01). Engrafman syndrome was detected in 5 patients (4.5%). Conclusion: CRP is an effective indicator of infection, but it is an acute phase reactant that can be detected in other cases with cytokine release. It can also be elevated in patients without an infection clinic and this suggests that CRP may be an early precursor of engraftment. Key Words: C-Reactive Protein, autologous hematopoietic stem cell transplantation, multiple myeloma, post-transplant infections