In the Journals

ST2 levels predicted acute GVHD, mortality after double-unit cord blood transplantation

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December 19, 2014

High levels of the biomarker suppressor of tumorigenicity 2 at 28 days post-cord blood transplantation independently predicted acute graft-versus-host disease, according to study results.

High levels of tumorigenicity 2 (ST2) also predicted transplant-related mortality, results showed.

Cord blood transplantation is an effective treatment option for high-risk hematologic malignancies. However, acute graft-versus-host disease (GVHD) is one of the primary causes of transplant-related mortality.

Doris M. Ponce, MD, of the adult bone marrow transplantation service at Memorial Sloan Kettering Cancer Center, and colleagues investigated the clinical significance of peripheral blood biomarker levels 28 days after double-unit cord blood transplantation.

All 113 patients in the analysis underwent the procedure at Memorial Sloan Kettering Cancer Center as part of treatment for hematologic malignancies.

Ponce and colleagues hypothesized that elevated biomarker levels on day 28 would be associated with subsequent development of grade III to IV acute GVHD.

Study results showed ST2 level was the only biomarker associated with grade II to grade IV acute GVHD, grade III to grade IV acute GVHD, and transplant-related mortality.

Rates of grade III to grade IV acute GVHD at 180 days post-transplant were 30% (95% CI, 18-43) among patients with ST2 levels >33.9 ng/ml at 28 days post-transplant vs. 13% (95% CI, 5-23) among patients with low ST2 levels at 28 days post-transplant (P=.024).

The effect of elevated ST2 levels was independent of human leukocyte antigen match, results showed.

Patients with high levels of ST2 at 28 days post-transplant also were more likely to experience transplant-related mortality within 180 days than those with low levels (28% vs. 5%; P=.001).

The most common cause of death among patients with high ST2 levels was GVHD. High concentrations of TNFR1, IL-8 and REG3a also were significantly associated with transplant-related mortality.

“Our results are consistent with those of adult donor allografts and warrant further prospective evaluation to facilitate future therapeutic intervention to ameliorate severe acute GVHD and improve survival in cord-blood transplantation recipients,” Ponce and colleagues wrote.

Disclosure: One researcher is a co-founder of, stockholder in and consultant to Juno Therapeutics. Another researcher reports a patent licensed to Viracor-IBT Laboratories.

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