title: Changes in circulating endothelial cells count could become a valuable tool in the diagnostic definition of acute graft-versus-host disease.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is burdened by life-threatening complications, with graft-versus-host disease (GvHD) being the major cause of morbility and mortality. Recently, clinical and physiopathologic evidences showed that vascular endothelium can be a target of GvHD in the early phase and circulating endothelial cells (CECs) represent surrogate markers of endothelial damage.
  
  
  METHODS
  Using the CellSearch System (Veridex LLC, Raritan, NJ), CECs were counted before (T1), after conditioning regimen (T2), at engraftment (T3), at GvHD onset (T4), and after steroid treatment (T5) in 40 patients (7 Hodgkin's Disease, 13 Acute Myeloblastic Leukemia, 5 Acute Lymphoblastic Leukemia, 8 Multiple Myeloma, 3 Chronic Lymphocytic Leukemia, 1 Non-Hodgkin Lymphoma, 1 Chronic Myeloid Leukemia, 2 Severe Aplastic Anemia) undergoing allo-HSCT.
  
  
  RESULTS
  The median CEC per milliliter at T1 was 20 (n=33, range 4-718), in comparison to a value of 2 (range, 1-14) in controls (P<0.001). At T3, CEC per milliliter were 47 (range, 16-148) in GvHD patients and 92 (range, 23-276) in patients without GvHD (P=0.006). This difference remained significant in multivariate analysis (odds ratio, 0.97; 95% confidence interval, 0.96-0.99; P=0.02). At GvHD onset, the relative increase of CEC counts from time of engraftment (T4 vs. T3) was 44% (range, -43% to 569%) in GvHD patients versus 0% (range, -49% to 2%) in patients without GvHD (P=0.003), being confirmed as significant in multivariate analysis (odds ratio, 1.04; 95% confidence interval, 1.0-1.08; P=0.04).
  
  
  CONCLUSIONS
  Changes in CEC count can represent a promising marker to monitor endothelial damage in patients undergoing allo-HSCT and could become a valuable tool in the diagnostic definition of GvHD.
authors.affiliation: 1 Laboratory for Stem Cells Manipulation and Cryopreservation, A.O. Spedali Civili, Brescia, Italy. 2 Department of Transfusion Medicine, A.O. Spedali Civili, Brescia, Italy. 3 Chair of Hematology, Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia, A.O. Spedali Civili, Brescia, Italy. 4 Address correspondence to: Camillo Almici, M.D., Laboratory for Stem Cells Manipulation and Cryopreservation, Department of Transfusion Medicine, A.O. Spedali Civili di Brescia, Pz.le Spedali Civili, 1-25123 Brescia, Italy.
authors.forename: Camillo
authors.initials: C
authors.lastname: Almici
authors.forename: Cristina
authors.initials: C
authors.lastname: Skert
authors.forename: Rosanna
authors.initials: R
authors.lastname: Verardi
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Palma
authors.forename: Andrea
authors.initials: A
authors.lastname: Bianchetti
authors.forename: Arabella
authors.initials: A
authors.lastname: Neva
authors.forename: Simona
authors.initials: S
authors.lastname: Braga
authors.forename: Michele
authors.initials: M
authors.lastname: Malagola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Turra
authors.forename: Mirella
authors.initials: M
authors.lastname: Marini
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D002469:Cell Separation; D042783:Endothelial Cells / Q000166:cytology*; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D006086:Graft vs Host Disease / Q000145:classification / Q000175:diagnosis*; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects