ST2 as a Marker for Risk of Therapy-Resistant Graft-Versus-Host Disease and Death

Study Questions:

What is the role of plasma biomarkers in characterizing the response of acute graft-versus-host-disease (GVHD) to therapy after allogeneic hematopoietic stem-cell transplantation?

Methods:

Plasma samples were collected prospectively between 2000 and 2010 from patients who underwent allogeneic hematopoietic stem-cell transplantation; retrospectively defined data sets were used to develop prediction models. A plasma proteomic approach was used to identify suppression of tumorigenicity 2 (ST2) as the single best biomarker (among a biomarker panel of 12) for predicting nonresponse to GVHD therapy and subsequent death without relapse. The associations between ST2 and treatment-resistant GVHD and 6-month mortality after treatment or transplantation were determined.

Results:

Compared to patients with low ST2 values at therapy initiation, patients with high ST2 values were 2.3 times as likely to have treatment-resistant GVHD (95% confidence interval [CI], 1.5-3.6) and 3.7 times as likely to die within 6 months after therapy (95% CI, 2.3-5.9).

Conclusions:

The authors concluded that ST2 is a plasma biomarker that has a significant association with resistance to GVHD therapy and subsequent death without relapse after allogeneic hematopoietic stem-cell transplantation.

Perspective:

The current analysis identifies the role of ST2 in improving the risk stratification of patients with GVHD. The limitations of the study aside, such findings may be helpful in the early identification of patients who will not have a response to GVHD therapy or to guide the use of additional therapies before the development of resistant disease.

Clinical Topics: Arrhythmias and Clinical EP

Keywords: Graft vs Host Disease, Recurrence, Chronic Disease, Biological Markers, Troponin I, Cardiology, Hematopoietic Stem Cell Transplantation, Proteomics


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