Hyperglycemia During the Neutropenic Period Is Associated With a Poor Outcome in Patients Undergoing Myeloablative Allogeneic Hematopoietic Stem Cell Transplantation.
Fuji, Shigeo 1; Kim, Sung-Won 1; Mori, Shin-ichiro 1; Fukuda, Takahiro 1; Kamiya, Shigemi 2; Yamasaki, Satoshi 1; Morita-Hoshi, Yuriko 1; Ohara-Waki, Fusako 1; Honda, Osamu 3; Kuwahara, Setsuko 2; Tanosaki, Ryuji 1; Heike, Yuji 1; Tobinai, Kensei 1; Takaue, Yoichi 1,4
84(7):814-820, October 15, 2007.
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Background. Recipients of allogeneic hematopoietic stem cell transplantation (HSCT) frequently require support with parenteral nutrition and immunosuppressive drugs, which introduce the risk of hyperglycemia. Van den Berghe et al. showed that the strict glucose control improved the outcome of patients treated in the intensive care unit, and this point was evaluated in this study in a HSCT setting.
Methods. A cohort of 112 consecutive adult patients treated by myeloablative allogeneic HSCT between January 2002 and June 2006 was reviewed retrospectively. Twenty-one patients were excluded due to graft failure, preexisting infectious diseases, preexisting neutropenia or previous allogeneic HSCT. The remaining 91 patients were categorized according to mean fasting blood glucose (BG) level in the neutropenic period after conditioning: normoglycemia (BG <110 mg/dL, n=28), mild hyperglycemia (110 to 150 mg/dL, n=49), and moderate/severe (>150 mg/dL, n=14). The primary endpoint was the occurrence of febrile neutropenia (FN) and documented infection during neutropenia, and the secondary endpoints included organ dysfunction according to the definition used by van den Berghe, acute graft-versus-host disease (GVHD), overall survival, and nonrelapse mortality (NRM).
Results. Although the incidence of FN or documented infections was similar between the three groups, hyperglycemia was significantly associated with an increased risk of organ dysfunction, grade II-IV acute GVHD, and NRM.
Conclusions. While the results suggested an association between the degree of hyperglycemia during neutropenia and an increased risk of posttransplant complications and NRM, the possibility that intensive glucose control improves the outcome after HSCT can only be confirmed in a prospective randomized trial.
(C) 2007 Lippincott Williams & Wilkins, Inc.