DefinePK

Abstract

Context:Allogeneic hematopoietic stem cell transplant (Allo-HCT) is a curative therapy for various hematological disorders; however, acute graft-versus-host disease (aGVHD) remains a significant cause of non-relapse mortality. Although histopathology remains the gold standard for diagnosis, delays in biopsy results can hinder timely management. Recent studies suggest that biomarkers such as suppression of tumorigenicity 2 (ST2) and regenerating islet-derived protein 3 alpha (Reg3a) may assist in early diagnosis and monitoring of aGVHD.
Objective:This study aimed to investigate the role of ST2 and Reg3a biomarkers in the diagnosis and post-treatment monitoring of aGVHD.
Methods:A prospective observational study was conducted at the Armed Forces Bone Marrow Transplant Center, CMH Rawalpindi, from July 2023 to December 2024. Patients undergoing Allo-HCT for malignancy and beta thalassemia major were included and monitored for clinical signs of aGVHD. ST2 and Reg3a levels were checked at day 0 and 45 of transplant. For patients developing GVHD, pre and post treatment samples were collected for comparison. Biomarker levels were correlated with clinical outcomes.
Results:            
A total of number of 15 patients were included, among which 7 patients developed GVHD while 8 patients were considered as controls. At day 0, no significant difference between cases and controls was observed in mean level of ST2 (7504.87 ng/mL vs 3603.41 ng/mL, p=0.19), or in mean level of Reg3a (29.33 ng/mL vs 34.89 ng/mL, p=0.24). However, at day 45, mean level of ST2 was significantly higher in those patients who subsequently developed GVHD (3984.17 ng/mL vs 1742.10 ng/mL, p=0.020) although mean Reg3a level did not show significant difference (29.08 ng/mL vs 32.66 ng/mL, p=0.519).
Comparing levels at onset with post treatment levels in cases, the role of biomarkers in post treatment monitoring was found to be insignificant (ST2: 5900.56 vs 5337.59, p= 0.65, Reg3a: 28.07 vs 23.92, p=0.10).
Conclusion:
The ST2 level can be a useful biomarker for predicting acute GVHD. More data with larger cohort is needed to establish clinical utility of ST2 in GVHD prediction and response monitoring.