Algorithm Can Identify Bone Marrow Transplant Patients at Risk of Graft-versus-host Disease

Algorithm Can Identify Bone Marrow Transplant Patients at Risk of Graft-versus-host Disease

A simple blood test could predict which bone marrow transplant patients are at high risk of developing graft-versus-host disease (GVHD) weeks before the condition becomes evident.

GVHD remains the major cause of non-relapse mortality among transplant patients, and its early detection could save many lives, researchers say.

The study, “An early-biomarker algorithm predicts lethal graft-versus-host disease and survival,” was published in JCI Insight.

Bone marrow transplants are the only way to cure patients with hematological, or blood-based, diseases such as leukemia and lymphoma. In these patients, the transplanted immune cells help fight the malignant cells, while the transplanted stem cells replenish the bone marrow with healthy blood cells.

But in 40-60% of patients with transplants, the donor immune cells recognize the patient’s healthy cells as foreign, launching immune responses that become lethal in 40 percent of cases.

Researchers at the Mount Sinai Acute GVHD International Consortium (MAGIC) have created an algorithm, called the MAGIC algorithm, that can determine a patient’s risk of developing GVHD weeks before the first symptoms appear.

The researchers examined blood samples from nearly 1,300 bone marrow transplant patients from 11 cancer centers. They found that blood levels of two proteins, ST2 and REG3a, one week after transplant can predict a patient’s risk of developing a lethal version of GVHD.

“The MAGIC algorithm gives doctors a roadmap to save many lives in the future. This simple blood test can determine which bone marrow transplant patients are at high risk for a lethal complication before it occurs,” James L.M. Ferrara, MD, co-director of MAGIC, said in a press release. “It will allow early intervention and potentially save many lives.” Ferrara is a professor of Pediatrics, Oncological Sciences and Medicine, Hematology and Medical Oncology at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai Hospital.

Doctors at Mount Sinai are designing clinical trials to assess if treating patients as soon as the test determines they are at high risk for severe GVHD will improve their prognosis.

“This test will make bone marrow transplant safer and more effective for patients because it will guide adjustment of medications to protect against graft-versus-host disease,” said John Levine, MD, MS, professor of Pediatrics and Medicine, Hematology and Medical Oncology at The Tisch Cancer Institute and co-director of MAGIC. “If successful, the early use of the drugs would become a standard of care for bone marrow transplant patients.”

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