Clinical applications for biomarkers of acute and chronic graft-versus-host disease

Abstract

Acute and chronic graft-versus-host disease (aGVHD, cGVHD) are serious complications of allogeneic hematopoietic cell transplantation. The complex pathophysiology of these disease processes is associated with immune system activation, the release of cytokines and chemokines, and alterations in cell populations. The blood levels of specific protein and cellular levels in patients with GVHD have correlated with the development, diagnosis, and prognosis of GVHD. Here, we review the most promising biomarkers for aGVHD and cGVHD with clinical relevance. The utility of GVHD biomarkers in clinical care of allogeneic hematopoietic cell transplantation recipients needs to be proven through clinical trials, and potential approaches to trial design are discussed.

Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1. Biomarker Research Steps

Figure 2. Biologically relevant BAFF and B cell markers in plasma, blood and bone marrow

A. Naïve and transitional B cells are increased in patients without cGVHD and these may serve as predictive markers of good post-HSCT health B. Low transitional and naïve B cell numbers and high BAFF/B cell ratios may serve as markers of cGVHD.

Figure 3. Possible Randomized, Double Blinded, Placebo-Controlled, Trial Design to Test GVHD Preemption