[HTML][HTML] An early-biomarker algorithm predicts lethal graft-versus-host disease and survival

MJ Hartwell, U Özbek, E Holler, AS Renteria… - JCI insight, 2017 - ncbi.nlm.nih.gov
MJ Hartwell, U Özbek, E Holler, AS Renteria, H Major-Monfried, P Reddy, M Aziz, WJ Hogan…
JCI insight, 2017ncbi.nlm.nih.gov
BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or
severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT)
prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT
were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a
training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1,
and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation …
Abstract
BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms.
METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n= 309) and validation set (n= 358).
RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P< 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P< 0.001) and the multicenter validation set (26% vs. 10%, P< 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P< 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P< 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset.
CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM.
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