Prediction of veno-occlusive disease using biomarkers of endothelial injury.
Predicting the development of veno-occlusive disease (VOD) of the liver remains challenging. We hypothesized that biomarkers of endothelial injury in myeloablative allogeneic transplantation recipients could predict VOD occurrence. We evaluated 4 biomarkers-von Willebrand Factor (vWF), thrombomodulin, E-selectin, and soluble intercellular adhesion molecule-1 (sICAM-1)-weekly in the peritransplantation period in an attempt to predict VOD. In the patients who received sirolimus, vWF, thrombomodulin, and sICAM-1 levels were significantly elevated in patients with VOD compared with those without VOD on day -1 (P <or= .035), day +7 (P <or= .0001), and day +14 (P <or= .004). E-selectin was predictive on day +7 (P = .007). Levels of vWF >or=1400 IU/mL and thrombomodulin >or=100 ng/mL on day +7 were both 100% sensitive and 100% specific in predicting VOD. These biomarkers were informative when adjusted for other risk factors for VOD in regression analysis. Among patients not receiving sirolimus, biomarkers of endothelial injury were not informative. We conclude that vWF, thrombomodulin, and sICAM-1 elevations before and early after transplantation may be useful in predicting VOD in patients receiving sirolimus.
Cutler
Corey
C
Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA. corey_cutler@dfci.harvard.edu
Kim
Haesook T
HT
Ayanian
Shaké
S
Bradwin
Gary
G
Revta
Carolyn
C
Aldridge
Julie
J
Ho
Vincent
V
Alyea
Edwin
E
Koreth
John
J
Armand
Philippe
P
Soiffer
Robert
R
Ritz
Jerome
J
Richardson
Paul G
PG
Antin
Joseph H
JH
D015415:Biomarkers / Q000097:blood; D019040:E-Selectin / Q000097:blood; D042783:Endothelial Cells / Q000378:metabolism / Q000473:pathology; D004730:Endothelium, Vascular / Q000293:injuries* / Q000378:metabolism; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006504:Hepatic Veno-Occlusive Disease / Q000097:blood* / Q000209:etiology / Q000473:pathology; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D018180:Thrombomodulin / Q000032:analysis; D014841:von Willebrand Factor / Q000032:analysis
D015415:Biomarkers; D019040:E-Selectin; C546936:SELE protein, human; C546931:THBD protein, human; D018180:Thrombomodulin; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1