title: Fecal calprotectin and alpha-1 antitrypsin predict severity and response to corticosteroids in gastrointestinal graft-versus-host disease.
abstract: Diagnosis of gastrointestinal GVHD (GI-GVHD) is based on clinical symptoms and histologic findings. No biomarkers predicting responses to treatment are routinely available even though 30% to 50% of patients will not respond to corticosteroids. In this study, we aimed to evaluate fecal calprotectin, α-1-antitrypsin (α(1)-AT), and elastase at the time of first symptoms as diagnostic and prognostic tools for GI-GVHD in 72 consecutive patients, of whom 51 developed GI-GVHD. The prognostic value of markers was evaluated by their association with complete response (CR) and steroid-resistant (SR) GVHD. Calprotectin and α(1)-AT concentrations increased with GI-GVHD initial stages but patients with initial stage 1 GI-GVHD had similar marker levels to patients without GI-GVHD, so sensitivity to diagnose GI-GVHD was weak. In contrast, calprotectin and α(1)-AT were predictors for SR-GVHD and CR. Multiple regression modeling identified calprotectin and α(1)-AT concentration as independently predicting SR-GVHD together with initial stage > 2 GI-GVHD. Our results showed that fecal calprotectin and α(1)-AT levels at the time of diagnosis are predictive for responses to treatment but are not diagnostic markers for initial stage 1 to 3 GI-GVHD.
authors.affiliation: Hematology Transplantation, Assistance Publique-Hôpitaux de Paris (AP-HP), Saint Louis Hospital, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Paula
authors.initials: P
authors.lastname: Rodriguez-Otero
authors.forename: Raphael
authors.initials: R
authors.lastname: Porcher
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Margarita
authors.initials: M
authors.lastname: Contreras
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Aliénor
authors.initials: A
authors.lastname: Xhaard
authors.forename: Annalisa
authors.initials: A
authors.lastname: Andreoli
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: Nathalie
authors.initials: N
authors.lastname: Kapel
authors.forename: Anne
authors.initials: A
authors.lastname: Janin
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D004351:Drug Resistance; D005243:Feces / Q000737:chemistry*; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000473:pathology*; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000378:metabolism; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D000515:alpha 1-Antitrypsin; D010196:Pancreatic Elastase