NEJM：ST2能作为治疗耐受性GVHD和死亡的分子标志物
2013-08-15 MedSci MedSci原创
目前尚没有任何标志物能预测同种异体造血干细胞移植后移植物急性排斥反应（GVHD）。作者从10位治疗中完全稳定的10位患者和10位出现急性GVHD患者血样进行比较，比较了12种血清来源的分子标志物，发现肿瘤形成抑制素2（suppression of tumorigenicity 2，ST2）是最显著的标志物。进一步在381位患者的血样中证实这一点。患者在移植起始阶段，ST2的水平低能预示6个月内
目前尚没有任何标志物能预测同种异体造血干细胞移植后移植物急性排斥反应（GVHD）。作者从10位治疗中完全稳定的10位患者和10位出现急性GVHD患者血样进行比较，比较了12种血清来源的分子标志物，发现肿瘤形成抑制素2（suppression of tumorigenicity 2，ST2）是最显著的标志物。进一步在381位患者的血样中证实这一点。患者在移植起始阶段，ST2的水平低能预示6个月内死亡风险也小。在移植后14天血浆中ST2水平能直接预示6个月无复发致死率。因此，在GVHD患者测量ST2水平，有助于对患者预后的判断。此篇文章发表在近期新英格兰期刊上。
ST2 as a marker for risk of therapy-resistant graft-versus-host disease and death.
Source
Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND:
No plasma biomarkers are associated with the response of acute graft-versus-host disease (GVHD) to therapy after allogeneic hematopoietic stem-cell transplantation.
METHODS:
We compared 12 biomarkers in plasma obtained a median of 16 days after therapy initiation from 10 patients with a complete response by day 28 after therapy initiation and in plasma obtained from 10 patients with progressive GVHD during therapy. The lead biomarker, suppression of tumorigenicity 2 (ST2), was measured at the beginning of treatment for GVHD in plasma from 381 patients and during the first month after transplantation in three independent sets totaling 673 patients to determine the association of this biomarker with treatment-resistant GVHD and 6-month mortality after treatment or transplantation.
RESULTS:
Of the 12 markers, ST2 had the most significant association with resistance to GVHD therapy and subsequent death without relapse. As compared with patients with low ST2 values at therapy initiation, patients with high ST2 values were 2.3 times as likely to have treatment-resistant GVHD (95% confidence interval [CI], 1.5 to 3.6) and 3.7 times as likely to die within 6 months after therapy (95% CI, 2.3 to 5.9). Patients with low ST2 values had lower mortality without relapse than patients with high ST2 values, regardless of the GVHD grade (11% vs. 31% among patients with grade I or II GVHD and 14% vs. 67% among patients with grade III or IV GVHD, P<0.001 for both comparisons). Plasma ST2 values at day 14 after transplantation were associated with 6-month mortality without relapse, regardless of the intensity of the conditioning regimen.
CONCLUSIONS:
ST2 levels measured at the initiation of therapy for GVHD and during the first month after transplantation improved risk stratification for treatment-resistant GVHD and death without relapse after transplantation. (Funded by the National Institutes of Health.)
原始出处：
Vander Lugt MT, Braun TM, Hanash S, Ritz J, Ho VT, Antin JH, Zhang Q, Wong CH, Wang H, Chin A, Gomez A, Harris AC, Levine JE, Choi SW, Couriel D, Reddy P, Ferrara JL, Paczesny S.ST2 as a marker for risk of therapy-resistant graft-versus-host disease and death.N Engl J Med. 2013 Aug 8;369(6):529-39
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