Cytokine production during myeloablative and reduced intensity therapy before allogeneic stem cell transplantation.

BACKGROUND AND OBJECTIVES The aim of this study was to elucidate the effect of the type of chemo-radio therapy given before allogeneic hematopoietic stem-cell transplantation (HSCT) on cytokine release. DESIGN AND METHODS We analyzed serum cytokine levels during pre-transplant therapy in 178 HSCT recipients. Samples were drawn daily during the treatment and serum levels of tumor necrosis factor-alpha (TNF-alpha) were analyzed by automated chemo-luminescence immunoassay. Conventional high-dose myeloablative therapy was given to 119 patients, while 59 patients received reduced intensity therapy (RIC). Most patients had a hematologic malignancy: their median age was 37 years (range 1-67). Anti-thymocyte globulin (ATG) was given to 126 patients as part of the pre-transplant treatment. RESULTS The use of ATG significantly increased the TNF-alpha levels in the last four days before transplantation. We found significantly higher TNF-alpha levels, days -4 to -2 before transplant, in patients given RIC compared to myeloablative therapy independently of ATG treatment. No effect of age or disease stage was found. In patients not given ATG, we found a correlation between high TNF-alpha levels on day -2 and moderate-to-severe acute graft-versus-host disease (GVHD). INTERPRETATION AND CONCLUSIONS To conclude, during the pre-transplant treatment for HSCT, patients receiving RIC and those treated with ATG had increased levels of TNF-alpha.