Biological markers of hemostasis and endothelial activation in patients with a hematological malignancy with or without stem cell transplants.

Introduction: In this study, we analyzed the changes of thrombin generation as marker of coagulation activation and von Willebrand factor (vWF) levels as a marker of endothelial activation in patients undergoing chemotherapy, autologous, or allogeneic HSCT. We studied possible associations to triggering factors, including acute GVHD, thrombosis, time to engraftment, and bleeding complications.

Methods: Seventy-six patients treated for hematologic malignancies at the University Hospital Basel between 2005 and 2008 took part in this study. Blood samples were collected before the start of chemotherapy or conditioning regime (median day -2), in an early phase (median day + 12), and at a later point in time (median day + 24).

Results: Thrombin generation decreased in all three groups to about 50% of the initial value. Patients undergoing autologous or allogeneic HSCT showed significantly (P = .026 and P = .01) higher vWF levels than patients undergoing chemotherapy. Eighteen patients (42%) receiving allogeneic HSCT developed GVHD, vWF levels in patients with GVHD were significantly (P = .008) higher than in patients without GVHD.

Discussion: Patients receiving autologous or allogeneic HSCT had significantly higher vWF levels in the acute phase after the transplant than patients receiving chemotherapy alone, implicating a persistent stimulation of the endothelium, possibly within the context of GVHD.