Decreased Serum Albumin as a Biomarker for Severe Acute Graft-versus-Host Disease after Reduced-Intensity Allogeneic Hematopoietic Cell Transplantation

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Decreased Serum Albumin as a Biomarker for Severe Acute Graft-versus-Host Disease after Reduced-Intensity Allogeneic Hematopoietic Cell Transplantation Andrew R. Rezvani, Barry E. Storer, Rainer F. Storb, Marco Mielcarek, David G. Maloney, Brenda M. Sandmaier, Paul J. Martin, George B. McDonald Biology of Blood and Marrow Transplantation Volume 17, Issue 11, Pages 1594-1601 (November 2011) DOI: 10.1016/j.bbmt.2011.07.021 Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 1 Change in absolute (A) and relative (B) serum albumin concentration in patients with peak grade 2 aGVHD (solid line) versus peak grade 3/4 aGVHD (dashed line). Albumin concentration (ordinate) is in grams per deciliter. Biology of Blood and Marrow Transplantation 2011 17, 1594-1601DOI: (10.1016/j.bbmt.2011.07.021) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 2 ROC curves for serum albumin as a predictor of peak grade 3/4 aGVHD. Dashed line represents ROC of absolute serum albumin concentration at initiation of systemic therapy for aGVHD. Solid line represents ROC of change in serum albumin concentration from baseline at initiation of systemic therapy for aGVHD. Biology of Blood and Marrow Transplantation 2011 17, 1594-1601DOI: (10.1016/j.bbmt.2011.07.021) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 3 OS from initiation of therapy for aGVHD. Solid line represents survival in patients with an insignificant albumin decrease (<0.5 g/dL), while dashed line represents survival in patients with an albumin decrease of ≥0.5 g/dL. Biology of Blood and Marrow Transplantation 2011 17, 1594-1601DOI: (10.1016/j.bbmt.2011.07.021) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 4 Cumulative incidents of relapse (A) and NRM (B), stratified by change in serum albumin at initiation of aGVHD treatment. Biology of Blood and Marrow Transplantation 2011 17, 1594-1601DOI: (10.1016/j.bbmt.2011.07.021) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 5 NRM from time of initiation of aGVHD treatment. “False-positive” line represents patients with an albumin decrease of ≥0.5 g/dL, but who did not progress to grade 3/4 aGVHD. Nonrelapse mortality is increased only in patients with an albumin decrease and severe aGVHD, suggesting that the prognostic value of albumin decrease is linked entirely to its ability to predict severe aGVHD. Biology of Blood and Marrow Transplantation 2011 17, 1594-1601DOI: (10.1016/j.bbmt.2011.07.021) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions

Figure 6 ROC curve for serum albumin decrease ≥0.5 g/dL alone (solid line) and in combination with other clinical factors (dashed line) in predicting progression to grade 3/4 aGVHD. The initial ROC curve (solid line) has an area under the curve of 0.76. The incorporation of other clinical variables (donor type, degree of HLA disparity, time to aGVHD onset, patient age, and bilirubin, creatinine, and platelet count at aGVHD treatment initiation) resulted in an ROC curve with an area under the curve of 0.79 (dashed line). Biology of Blood and Marrow Transplantation 2011 17, 1594-1601DOI: (10.1016/j.bbmt.2011.07.021) Copyright © 2011 American Society for Blood and Marrow Transplantation Terms and Conditions