Disease risk and GVHD biomarkers can stratify patients for risk of relapse and nonrelapse mortality post hematopoietic cell transplant
| Autor: | Steven Kowalyk, Mohammed S. Chaudhry, Elisabeth Schreiner, John E. Levine, Wolf Rösler, Rachel Young, Rainer Ordemann, Matthias Wölfl, Francis Ayuk, Jay Shah, Aaron Etra, Sarah Anand, Christina Dimopoulos, Matthew J. Hartwell, Elizabeth O. Hexner, Tal Schechter, Umut Ozbek, Yi-Bin Chen, Kitsada Wudhikarn, Carrie L. Kitko, Mina Aziz, Hannah K. Choe, James L.M. Ferrara, Pietro Merli, Michael A. Pulsipher, Ran Reshef, Stephanie Gergoudis, William J. Hogan, George Morales, Hrishikesh K. Srinagesh, Muna Qayed, Urvi Kapoor, Ryotaro Nakamura, Nicolaus Kröger, Gregory A. Yanik, Allan Augustine |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Oncology Cancer Research medicine.medical_specialty Transplantation Conditioning medicine.medical_treatment Population Graft vs Host Disease Hematopoietic stem cell transplantation Relapse prevention Article 03 medical and health sciences 0302 clinical medicine Risk Factors immune system diseases hemic and lymphatic diseases Internal medicine medicine Humans Transplantation Homologous Risk factor education Survival rate education.field_of_study business.industry Hematopoietic Stem Cell Transplantation Immunosuppression Hematology Prognosis Survival Rate Transplantation surgical procedures operative 030104 developmental biology Hematologic Neoplasms 030220 oncology & carcinogenesis Neoplasm Recurrence Local Risk assessment business Algorithms Biomarkers Follow-Up Studies |
| Zdroj: | Leukemia |
| ISSN: | 1476-5551 0887-6924 |
| DOI: | 10.1038/s41375-020-0726-z |
| Popis: | The graft-versus-leukemia (GVL) effect after allogeneic hematopoietic cell transplant (HCT) can prevent relapse but the risk of severe graft-vs-host disease (GVHD) leads to prolonged intensive immunosuppression and possible blunting of the GVL effect. Strategies to reduce immunosuppression in order to prevent relapse have been offset by increases in severe GVHD and non-relapse mortality (NRM). We recently validated the MAGIC algorithm probability (MAP) that predicts the risk for severe GVHD and NRM in asymptomatic patients using serum biomarkers. In this study we tested whether the MAP could identify patients whose risk for relapse is higher than their risk for severe GVHD and NRM. The multicenter study population (n=1604) was divided into two cohorts: historical (2006–2015, n=702) and current (2015–2017, n=902) with similar non-relapse mortality, relapse, and survival. On day 28 post-HCT, patients who had not developed GVHD (75% of the population) and who possessed a low MAP were at much higher risk for relapse (24%) than severe GVHD and NRM (16% and 9%); this difference was even more pronounced in patients with a high disease risk index (relapse 33%, NRM 9%). Such patients are good candidates to test relapse prevention strategies that might enhance GVL. |
| Databáze: | OpenAIRE |
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