Finding should result in safer stem cell transplants from donors

Blood-forming stem cells donated by family members and good Samaritans save the lives of thousands of patients with blood cancers such as leukemia every year. But of the 20,000 such transplants each year around half result in a severe and frequently fatal complication known as Graft Versus Host Disease (GVHD).

Now, a multi-institutional team has found a molecule in the blood of patients who are most likely to develop the severe form of GVHD. Knowing about this molecule should allow doctors tailor more aggressive treatment to those patients most at risk and intervene earlier, perhaps before the complication manifests in the patients.

GVHD occurs when the donated stem cells produce immune cells that recognize the tissues of the patient as foreign and attacks them. This attack from the new donor immune system often focuses on linings the intestinal system and can be quite painful. It typically does not strike until about 30 days after the transplant, but the research team found evidence of the biomarker called ST2 as early as 14 days after transplant pointing to the possibility of early intervention.

The team included researchers from Indiana University, the University of Michigan, the Fred Hutchison Cancer Center and the Dana-Farber Cancer Institute. It was published in today’s New England Journal of Medicine, and a press release from IU was picked up by this news site. It quoted the team’s senior author from IU Sophie Paczesny:

“This blood test, which is currently available to clinicians, will make informed treatment possible as the clinicians will now be able to adjust therapy to the degree of risk rather than treating every patient the same way.”

For patients lucky enough to have an immunologically matched relative, the chances of GVHD are around 40 percent. But for those who have to rely on unrelated donors the risk can be as high as 60 to 80 percent. So, knowing who to treat early and aggressively could save considerable pain and suffering as well as lives.

The blood-forming stem cells used to treat leukemia come from either bone marrow or cord blood transplants. For a primer on the various types of stem cells visit our Stem Cell Basics.

Don Gibbons

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