Telltale signs. Production of elafin (stained brown) by the skin cells in the upper layer of skin GVHD distinguish other types of skin rashes.
S. Paczesny et al. Science
Researchers have developed a new blood test to diagnose and predict the severity of graft against host disease (GVHD), a complication often fatal that strikes people who have received a bone marrow transplant for cancer or other conditions. The test could help doctors decide quickly patients who need critical treatment.
GVHD is the equivalent of organ rejection syndrome in bone marrow transplant patients. The disease begins when the immune cells in the bone marrow of the donor recognize the recipient's cells as foreign and launch an attack. The initial clinical symptom is often a rash, which sometimes makes it difficult early diagnosis. But if allowed to progress, the disease can damage internal organs and proves fatal in 30% to 40% of cases. Outside the relapse of a person's disease, GVHD is the leading cause of death for patients who received a bone marrow donation
Due to the severity of GVHD, clinicians often start the treatment. - In high doses of steroids to suppress the immune response - in the absence of a diagnosis of concrete. But this preventive strategy can also be dangerous, increasing the risk of infections and may increase the risk of relapse in cancer patients. "There is a feeling that we overtreating some patients and other undertreating," said pediatric oncologist and co-author James Ferrara, University of Michigan, Ann Arbor.
To facilitate early diagnosis, Ferrara's team took weekly samples of plasma from patients who had received a bone marrow donation They compared levels elafin. - anti-inflammatory protein produced by the body in response to GVHD of the skin - 10 patients who had developed the disease and 20 patients who did not. on average, elafin levels in patients developing GVHD of the skin have been three times higher, the researchers report online today in Science Translational Medicine .
Next, the researchers divided 159 patients with the disease in two groups with --those higher than the mean plasma concentrations of elafin and those with lower average levels - and then the long-term survival of each group. After 12 months, three times as many patients in the high elafin group had died from GVHD and its complications in the group with low elafin. "In the future, hopefully a clinician may be able to test Elafin levels of a transplant patient with a rash decide to start treatment," said Ferrara. If, as the researchers suspect, elafin of the levels increase before symptoms develop GVHD, it might also be possible to identify patients at risk who do not have a rash.
hematological oncologist Corey Cutler of Harvard Medical School in Boston noted that GVHD can often be diagnosed just by careful examination of the rash, but a more definitive diagnostic test would be welcome. "If this test could predict the onset of GVHD before the rash develops, it could be extremely valuable," he said.
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