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Acute Leukemias

Clinical laboratory markers of inflammation as determinants of chronic graft-versus-host disease activity and NIH global severity

Leukemia volume 26, pages 633–643 (2012)Cite this article

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.

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Acknowledgements

This study was supported by the Intramural Research Program of the National Institutes of Health, Center for Cancer Research and National Cancer Institute. We thank Dr N Rehak, Dr Katherine Calvo and Dr Irina Maric, Department of Laboratory Medicine, Clinical Center, NIH for providing the clinical laboratory methods information. Lana Grkovic is a participant in the NIH Graduate Partnership Program and a post-graduate student at the Division of Hematology, University of Zagreb, School of Medicine, Zagreb, Croatia. Kathryn J Martires was supported by the Clinical Research Training Program, a public–private partnership supported jointly by the NIH and Pfizer Inc. (via a grant to the Foundation for NIH from Pfizer Inc.).

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Authors and Affiliations

  1. Graft-versus-Host and Autoimmunity Unit, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    L Grkovic, K M Williams, F T Hakim, D N Avila, T N Taylor, R B Salit, D H Fowler, M R Bishop, R E Gress & S Z Pavletic

  2. Division of Hematology, Department of Internal Medicine, Clinical Hospital Center Zagreb, Zagreb, Croatia

    L Grkovic & D Pulanic

  3. Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    K Baird

  4. Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    S M Steinberg & D Zhang

  5. Dermatology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    E W Cowen & K J Martires

  6. Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    S A Mitchell

  7. John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA

    S D Rowley

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Correspondence to S Z Pavletic.

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Grkovic, L., Baird, K., Steinberg, S. et al. Clinical laboratory markers of inflammation as determinants of chronic graft-versus-host disease activity and NIH global severity. Leukemia 26, 633–643 (2012). https://doi.org/10.1038/leu.2011.254

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