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Von Willebrand factor as a potential predictive biomarker of early complications of endothelial origin after allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation (2024)Cite this article

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Vascular endothelial syndrome is a dreadful post-allogeneic hematopoietic stem cell transplant (alloHSCT) complication, which includes capillary leak syndrome (CLS), engraftment syndrome (ES), transplant-associated thrombotic microangiopathy (TA-TMA), idiopathic pneumonia syndrome (IPS) and diffuse alveolar hemorrhages (DAH) [1, 2]. The development of prognostic scores quantifying comorbidities, disease- and donor-specific risks allowed better prediction of alloHSCT-related complications [3,4,5]. In recent years, the EASIX score has been developed to reflect endothelial injury and its associated mortality [5]. Von Willebrand factor (VWF), a large multimeric plasmatic glycoprotein playing a critical role in hemostasis by mediating platelet-platelet interactions and platelet-vessel adhesion, is a biomarker of endothelial dysfunction and systemic inflammation [6]. As endothelial dysfunction remains a clinical challenge [7, 8] and is increasingly involved in many complications after alloHSCT, we conducted a retrospective study to assess the role of VWF as a predictive biomarker of transplant-related endothelial dysfunction after alloHSCT.

We included 127 consecutive adult patients having received an alloHSCT for any type of hematological disease (median age: 57 years old, 77% of myeloid diseases), with any type of donor or conditioning regimen between February 2019 and November 2021. No patients had known von Willebrand disease or hemophilia A, nor were they treated with intra-venous immunoglobulins as part of their conditioning regimens. See Table S1 in supplemental for complete patients’ characteristics. We performed turbidimetric assays of VWF levels and binding capacity to platelet GPIbIX (respective ISTH nomenclature “VWF:Ag” and “VWF:RCo”, see Supplemental for references) on day −4, day 0 and day +28 of alloHSCT. Diagnosis of transplant-related endothelial dysfunction and sepsis was assigned retrospectively by performing systematic retrospective chart review [1, 8].

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Fig. 1: VWF is a risk factor of post-alloSCT endothelial syndrome and poor OS.

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Authors and Affiliations

  1. Service d’Hématologie, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium

    Guillaume Dachy, Marine Vankeerbergen, Nicolas Vanlangendonck, Nicole Straetmans, Catherine Lambert, Cédric Hermans & Xavier Poiré

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  1. Guillaume Dachy
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Contributions

GD took care of the patients, collected and analyzed the data and wrote the manuscript ; MV took care of the patients and collected the data ; NV collected the data ; NS took care of the patients and helped write the manuscript ; CL took care of the patients and helped write the manuscript ; CH took care of the patients and helped write the manuscript ; XP took care of the patients, designed the study and wrote the manuscript.

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Correspondence to Guillaume Dachy.

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Dachy, G., Vankeerbergen, M., Vanlangendonck, N. et al. Von Willebrand factor as a potential predictive biomarker of early complications of endothelial origin after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02242-1

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