Role of Biomarkers in Diagnosing and Post-Treatment Monitoring of Acute Graft-vs-Host Disease

Afsheen liaqat; Dr Nadia Sial Sial; Dr Mehwish Gilani; Maryam khan; Dr Tariq Ghafoor; Dr Raheel Iftikhar

Authors

Afsheen liaqat Armed forces bone marrow transplant centre
Nadia Sial Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Mehwish Gilani Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
maryam khan Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Tariq Ghafoor Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan
Raheel Iftikhar Department of Clinical Hematology and Bone Marrow Transplant, National University of Medical Sciences, Rawalpindi, Pakistan

Keywords:

Graft-versus-host disease , Biomarkers, Reg3a

Abstract

Objective: This study aimed to investigate the role of ST2 and Reg3a biomarkers in the diagnosis and post-treatment monitoring of aGVHD.

Methods: A prospective observational study was conducted at the Armed Forces Bone Marrow Transplant Center, CMH Rawalpindi, from July 2023 to December 2024. Patients undergoing Allo-HCT for malignancy and beta thalassemia major were included and monitored for clinical signs of aGVHD. ST2 and Reg3a levels were checked at day 0 and 45 of transplant. For patients developing GVHD, pre and post treatment samples were collected for comparison. Biomarker levels were correlated with clinical outcomes.

Results: A total of number of 15 patients were included, among which 7 patients developed GVHD while 8 patients were considered as controls. At day 0, no significant difference between cases and controls was observed in mean level of ST2 (7504.87 ng/mL vs 3603.41 ng/mL, p=0.19), or in mean level of Reg3a (29.33 ng/mL vs 34.89 ng/mL, p=0.24). However, at day 45, mean level of ST2 was significantly higher in those patients who subsequently developed GVHD (3984.17 ng/mL vs 1742.10 ng/mL, p=0.020) although mean Reg3a level did not show significant difference (29.08 ng/mL vs 32.66 ng/mL, p=0.519).

Comparing levels at onset with post treatment levels in cases, the role of biomarkers in post treatment monitoring was found to be insignificant (ST2: 5900.56 vs 5337.59, p= 0.65, Reg3a: 28.07 vs 23.92, p=0.10).

Conclusion: The ST2 level can be a useful biomarker for predicting acute GVHD. More data with larger cohort is needed to establish clinical utility of ST2 in GVHD prediction and response monitoring.