The Role of Procalcitonin in Hematopoietic Stem Cell Transplant: A Systematic Literature Review

Purpose: Hematopoietic stem cell transplant (HSCT) is an essential component in the therapy for numerous hematologic malignancies. Post-transplant infectious complications are a major concern and are often difficult to distinguish from other complications, particularly Graft vs Host Disease (GVHD). Therefore, a suitable differential diagnostic indicator is needed. Procalcitonin is an inflammatory marker that is elevated in the presence of infection. The purpose of this literature review was to gain a deeper understanding for the role of procalcitonin in distinguishing infection from other causes of fever in HSCT patients.

Methods: A systematic review using PubMed and Ovid databases was performed to retrieve the most recent studies that evaluated procalcitonin values during infectious episodes in HSCT patients.  Key terms such as procalcitonin, hematopoietic stem cell transplant and infection were used. Studies from peer-reviewed journals and clear monitoring parameters of procalcitonin before and after HSCT were included. Articles were critiqued on the design, patient population selection, methodology, results and conclusions.  

Results: The literature search identified five relevant studies that were eligible to be reviewed.  Four articles were prospective and one article was a retrospective study. All articles affirmed that there was a correlation between procalcitonin and the incidence of bacterial or fungal infection. In the incidence of GVHD, the serum levels remained within normal limits. However, one study claimed the trend was not significant. The largest study with the least confounding variables concluded that there is indeed a significant importance of procalcitonin in HSCT patients, regardless of concomitant steroid therapy.

Conclusion: Procalcitonin has been shown to have a definite correlation with the incidence of infection in HSCT patients. Further investigation is needed in a large patient population to adequately confirm the link between procalcitonin and HSCT associated infectious complications.