Disease risk and GVHD biomarkers can stratify patients for risk of relapse and nonrelapse mortality post hematopoietic cell transplant

Aziz MD, Shah J, Kapoor U, Dimopoulos C, Anand S, Augustine A, Ayuk F, Chaudhry M, Chen YB, Choe HK, Etra A, Gergoudis S, Hartwell MJ, Hexner EO, Hogan WJ, Kitko CL, Kowalyk S, Kroeger N, Merli P, Morales G, Nakamura R, Ordemann R, Pulsipher MA, Qayed M, Reshef R, Rösler W, Schechter T, Schreiner E, Srinagesh H, Woelfl M, Wudhikarn K, Yanik G, Young R, Ozbek U, Ferrara JLM, Levine JE (2020)

Publication Type: Journal article

Publication year: 2020

Journal

DOI: 10.1038/s41375-020-0726-z

Abstract

The graft-versus-leukemia (GVL) effect after allogeneic hematopoietic cell transplant (HCT) can prevent relapse but the risk of severe graft-versus-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 nonrelapse 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 NRM, 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.

Authors with CRIS profile

Involved external institutions

Icahn School of Medicine at Mount Sinai United States (USA) (US) University of Michigan United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Massachusetts General Hospital United States (USA) (US) Ohio State University United States (USA) (US) University of Pennsylvania United States (USA) (US) Mayo Clinic United States (USA) (US) Vanderbilt University United States (USA) (US) Ospedale Pediatrico Bambino Gesu Italy (IT) City of Hope Medical Center United States (USA) (US) Technische Universität Dresden Germany (DE) Children's Hospital Los Angeles United States (USA) (US) Emory University United States (USA) (US) Columbia University United States (USA) (US) University of Toronto Canada (CA) Universität Regensburg Germany (DE) Julius-Maximilians-Universität Würzburg Germany (DE) Chulalongkorn University / จุฬาลงกรณ์มหาวิทยาลัย Thailand (TH)

How to cite

APA:

Aziz, M.D., Shah, J., Kapoor, U., Dimopoulos, C., Anand, S., Augustine, A.,... Levine, J.E. (2020). Disease risk and GVHD biomarkers can stratify patients for risk of relapse and nonrelapse mortality post hematopoietic cell transplant. Leukemia. https://doi.org/10.1038/s41375-020-0726-z

MLA:

Aziz, Mina D., et al. "Disease risk and GVHD biomarkers can stratify patients for risk of relapse and nonrelapse mortality post hematopoietic cell transplant." Leukemia (2020).

BibTeX: Download