الفهرس | Only 14 pages are availabe for public view |
Abstract Graft-versus-host disease (GVHD) continues to compromise the overall success of allogeneic hematopoietic cell transplantation (HCT). Although rates and severity of acute GVHD have decreased with improvements in donor selection criteria, pharmacologic prophylaxes, and supportive care, rates of chronic GVHD have remained remarkably stable at 35% to 50% for many years. Follistatin is an angiogenic factor elevated in the circulation after allogeneic hematopoietic cell transplantation (HCT). Elevations in follistatin plasma concentrations are associated with the onset of and poor survival after acute graft versus host disease (aGVHD) We have identified an association between baseline recipient circulating plasma follistatin levels with the subsequent development of aGVHD, and we have further shown that day 28 follistatin is increased among individuals experiencing early aGVHD and mortality after allogeneic HCT. This study demonstrates its utility as a prospective biomarker for aGVHD risk. Our findings are complementary to previous work examining biomarkers in GVHD and support the use of biomarkers to predict onset and treatment response of certain post-HCT complications.Given the multiple roles of follistatin in angiogenesis, inflammation, and metabolism, it remains unclear whether elevated follistatin levels are in response to ongoing tissue damage and inflammation, or whether follistatin is antagonizing other angiogenic or inflammatory factors that are perpetuating tissue injury. Follistatin, and other factors, have the potential to be used clinically in risk prediction models to most successfully identify patients at highest risk for developing aGVHD and to predict those who are most likely to fail initial therapy or require more aggressive treatment. In This study we conducted on 45 patients with Hematological diseases from Ain Shams University hospital and Maadi Military hospital, BMT unit, (31 male, 14 female) with age range (18-64) years old who underwent allogeneic stem cell transplant (Matched related & Haplo), after obtaining a written informed consent from the patients. In our study 24 patients had acute GVHD, 3 patients had Mild Acute GVHD 6.7%, 11 patients had Moderate Acute GVHD 24.4% while 10 patients had Severe Acute GVHD 22.2%. In relation to follistatin level pre-Transplant (Day Zero) and post-Transplant (D+28), Acute GVHD incidence in pretransplant (Day zero) (98.64 +-58.5) is higher than posttransplant (Day +28) (85.8 +-52.1) P. value (0.13, 0.12) respectively. There is statistically insignificant difference of mean follistatin level at day zero and day 28 between cases with Acute GVHD and cases without acute GVHD (P.>0.05). In our study 88.9% of patients did not have chronic GVHD, 6.7% of them had skin chronic GVHd, 4,4% had skin and GIT chronic GVHD. There is statistically insignificant difference of mean follistatin level at day zero and day + 28 according to manifestations of chronic GVHD. In our study there is statistically significant difference of the incidence of infection in the study group with highest distribution of bacterial infection (42.2%), and lowest distribution with viral infection (2.2%) (P < 0.05). No statistically difference between the mean follistatin level at day zero and day 28 and the development of infection OS at D +90 is 55% and at D+180 53.5% DFS at D+90 is 52.2% and the same at D+180 Cases with Follistatin ≤ 90 pg/ml are insignificantly associated with higher mean OS (156.30) in comparison to cases with Follistatin > 90 pg/ml, that have lower mean OS (109.50), with follow up for 180 days Incidence of high OS is insignificantly higher 3.216 times in cases with Follistatin ≤ 90 pg/ml than cases with Follistatin > 90 pg/ml (HR=3.216,).P. value Follistatin ≤ 90 pg/ml are insignificantly associated with higher mean DFS (156.30) in comparison to cases with Follistatin > 90 pg/ml, that have lower mean DFS (109.50), Incidence of high DFS is insignificantly higher 3.216 times in cases with Follistatin ≤ 90 pg/ml than cases with Follistatin > 90 pg/ml (HR=3.216). |