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Graft-Versus-Host Disease

B-cell activating factor (BAFF) plasma level at the time of chronic GvHD diagnosis is a potential predictor of non-relapse mortality

Bone Marrow Transplantation volume 52, pages 1010–1015 (2017)Cite this article

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Abstract

Biological markers for risk stratification of chronic GvHD (cGvHD) could improve the care of patients undergoing allogeneic hematopoietic stem cell transplantation. Increased plasma levels of B-cell activating factor (BAFF), chemokine (C-X-C motif) ligand 9 (CXCL9) and elafin have been associated with the diagnosis, but not with outcome in patients with cGvHD. We evaluated the association between levels of these soluble proteins, measured by ELISA at the time of cGvHD diagnosis and before the initiation of therapy, with non-relapse-mortality (NRM). Based on the log-transformed values, factor levels were divided into tertiles defined respectively as low, intermediate, and high levels. On univariable analysis, BAFF levels were significantly associated with NRM, whereas CXCL9 and elafin levels were not. Both low (⩽2.3 ng/mL, hazard ratio (HR)=5.8, P=0.03) and high (>5.7 ng/mL, HR=5.4, P=0.03) BAFF levels were associated with a significantly higher NRM compared with intermediate BAFF level. The significant effect of high or low BAFF levels persisted in multivariable analysis. A subset of cGvHD patients had persistently low BAFF levels. In conclusion, our data show that BAFF levels at the time of cGvHD diagnosis are associated with NRM, and also are potentially useful for risk stratification. These results warrant confirmation in larger studies.

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Acknowledgements

We thank the clinicians, clinical research support staff and data managers in the University of Michigan Blood and Marrow Transplant Program. We acknowledge our funding sources including: MCube, University of Michigan, Briskin/Schlafer Pediatric Oncology Investigators Fund (to CLK), University of Michigan Pediatric Hematology/Oncology Junior Faculty Grant (to CLK); and NIH (NHLBI) R01 HL 129061-01 (to SS).

Author contributions

RMS conceived and performed statistical analyses, interpreted data and wrote the manuscript; SS interpreted the data and wrote the manuscript; CLK accrued patients and discussed data, and edited the manuscript; AP, SCG and JM accrued patients and discussed data; TC and HJ collected and managed data; AA, SP and PR contributed to research discussion, DRC conceived and designed the study, collected clinical data and assured quality and wrote the manuscript.

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Author notes

  1. R M Saliba and S Sarantopoulos: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    R M Saliba & A M Alousi

  2. Division of Cell Therapy and Hematologic Malignancies, Duke Cancer Institute, Duke University, Durham, NC, USA

    S Sarantopoulos

  3. Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA

    C L Kitko

  4. Adult Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, MI, USA

    A Pawarode, S C Goldstein, J Magenau, T Churay, H Justman & P Reddy

  5. Department of Pediatrics, Microbiology and Immunology, Indiana University School of Medicine, Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA

    S Paczesny

  6. Blood and Marrow Transplantation Program, Huntsman Cancer Institute, University of Utah Hospital, Salt Lake City, UT, USA

    D R Couriel

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Correspondence to D R Couriel.

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Saliba, R., Sarantopoulos, S., Kitko, C. et al. B-cell activating factor (BAFF) plasma level at the time of chronic GvHD diagnosis is a potential predictor of non-relapse mortality. Bone Marrow Transplant 52, 1010–1015 (2017). https://doi.org/10.1038/bmt.2017.73

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