University of Michigan researchers have identified the first biomarker of graft-versus-host disease (GvHD) of the skin, opening the door to the possibility of a blood test.
Until now, a skin biopsy has been the only reliable way to determine whether the rash that is common in bone marrow recipients is caused by antibiotics or is instead GVHD of the skin, where the disease appears in about half of cases.
Because a definitive diagnosis is difficult, the decision is often made to prescribe systemic high-dose steroids to suppress GVHD, which further weaken a patient's already compromised immune system.
The researchers, led by James Ferrara, MD, the Ruth Heyn Endowed Professor of Pediatrics and Communicable Diseases and Director of the Bone Marrow Transplant Program, identified a signature protein of GvHD of the skin called elafin.
Dr. Ferrara noted that the hope is to make the test available to clinicians soon.
“This blood test can determine the risk a patient may have for further complications, and thus physicians will be able to adjust therapy to the degree of risk, rather than treating every patient in exactly the same way,” he said. “For example, patients at low risk do not need to have additional medicine to further suppress their immune systems. Or patients with high levels who do not respond rapidly to standard treatment could be treated with additional therapy.”
Another finding in the study, published in Science Translational Medicine, was that bone marrow transplant patients with high levels of elafin were more likely to die of GVHD compared with patients with low levels.
First author of the study was Sophie Paczesny, MD, PhD, Assistant Professor of Pediatric Hematology-Oncology; and the research team also included collaborators from Fred Hutchinson Cancer Research Center.