Baseline Inflammatory Cytokines Predicted Rapid Increase in Symptom Severity to Nadir of Allogeneic BMT.

Patients who undergo allogeneic BMT experience a rapid increase in multiple symptoms, including pain, fatigue, poor appetite, drowsiness, dry mouth, and disturbed sleep, from pre-BMT to nadir of white blood cell count. The objective of this study was to prospectively evaluate baseline levels of serum inflammatory cytokines and other factors related to symptom development from pre-BMT to nadir.

Methods: Repeated multiple-symptom assessments with the M. D. Anderson Symptom Inventory (MDASI) were completed for 30 patients with AML/MDS at day of hospital admission (baseline), day of conditioning, day of BMT, day of nadir, and day 11 of BMT. A panel of serum inflammatory cytokines (IL-1ra, IL-6, IL-8, IL-10, IL-12, TNF-a) was assayed at baseline, conditioning, day of BMT, day after BMT, and at nadir.

Results: Patients self reported multiple symptoms that peaked 3 days after nadir. We adjusted for potential confounding factors, including age, sex, race, disease status pre-BMT, infusion dose of CD34+, and conditioning regimen, that could have affected symptom outcomes in the mixed effect models for symptom severity. Race was the only significant factor affecting the severity of the baseline symptom cluster (pain, fatigue, poor appetite, disturbed sleep, drowsiness, and dry mouth) and the change in symptom severity from baseline to peak (P<.0001). We were interested to know if baseline cytokines had any role in symptom development. Of the panel of cytokines tested, IL-6, IL-8, and IL-1b were significant predictors of the severity of symptom cluster from baseline to peak (estimated values from mixed modeling were 1.196, −3.707, and 6.055, all P<.05).

Conclusion: These results provide the first evidence of the role of baseline serum pro-inflammatory cytokines in symptom development from pre-BMT to symptom peak around nadir in patients with AML/MDS who have undergone allogeneic BMT.