title: Clinical laboratory markers of inflammation as determinants of chronic graft-versus-host disease activity and NIH global severity.
abstract: Chronic graft-versus-host disease (cGVHD) remains a major cause of non-relapse morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Currently there are no accepted measures of cGVHD activity to aid in clinical management and disease staging. We analyzed clinical markers of inflammation in the sera of patients with established cGVHD and correlated those with definitions of disease activity. In all, 189 adults with cGVHD (33% moderate and 66% severe according to National Institutes of Health (NIH) global scoring) were consecutively enrolled onto a cross-sectional prospective cGVHD natural history study. At the time of evaluation, 80% were receiving systemic immunosuppression and failed a median of four prior systemic therapies (PST) for their cGVHD. Lower albumin (P<0.0001), higher C-reactive protein (P = 0.043), higher platelets (P = 0.030) and higher number of PST (P<0.0001) were associated with active disease defined as clinician's intention to intensify or alter systemic therapy due to the lack of response. Higher platelet count (P = 0.021) and higher number of PST (P<0.0001) were associated with more severe diseased defined by NIH global score. This study identified common laboratory indicators of inflammation that can serve as markers of cGVHD activity and severity.
authors: Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
authors: L
authors: L
authors: Grkovic
authors: K
authors: K
authors: Baird
authors: S M
authors: SM
authors: Steinberg
authors: K M
authors: KM
authors: Williams
authors: D
authors: D
authors: Pulanic
authors: E W
authors: EW
authors: Cowen
authors: S A
authors: SA
authors: Mitchell
authors: F T
authors: FT
authors: Hakim
authors: K J
authors: KJ
authors: Martires
authors: D N
authors: DN
authors: Avila
authors: T N
authors: TN
authors: Taylor
authors: R B
authors: RB
authors: Salit
authors: S D
authors: SD
authors: Rowley
authors: D
authors: D
authors: Zhang
authors: D H
authors: DH
authors: Fowler
authors: M R
authors: MR
authors: Bishop
authors: R E
authors: RE
authors: Gress
authors: S Z
authors: SZ
authors: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D002908:Chronic Disease; D003176:Complement C3 / Q000032:analysis; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D003176:Complement C3; D016207:Cytokines; D002097:C-Reactive Protein