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Protecting Cancer Patients

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Identifying high-risk patients following stem cell transplant

For many cancer patients, the transplant of stem cells from a donor is potentially a life-saving treatment. However, there is a risk that donor cells can attack the patient receiving them in a disease called acute graft versus host disease (aGVHD), a potentially life-threatening condition following cell transplantation. Innovative tests, offered by Eurofins, can predict the risk of rejection so that the best patient care can be planned for.

Stem cell transplants, including peripheral blood, bone marrow, and cord blood transplants, can be used to treat cancer, most often those affecting blood or the immune system, like leukemia, lymphoma, or multiple myeloma. Bone marrow and stem cell transplant treatments use very high doses of chemotherapy, sometimes coupled with radiotherapy, to try to eliminate cancer cells. While the high dose treatment can kill cancer cells, it also can remove the stem cells in bone marrow that produce blood cells. Soon after treatment, stem cells from a donor are given to a patient to replace those that were destroyed. The donor stem cells make their way into bone marrow and start to produce healthy blood cells again. A bone marrow or stem cell transplant from another person, either from a matched relative or an unrelated donor, is called allogeneic hematopoietic stem cell transplantation (HSCT).

While potentially life-saving, allogeneic HSCT can also lead to the development of acute graft versus host disease (aGVHD). aGVHD is caused by immune dysregulation that is initiated when particular types of allogeneic white blood donor cells (the graft) react against the cells of the patient (the host) receiving them. The donated cells recognise the host as foreign and attack, damaging host tissue, and releasing inflammation fostering substances into the body. aGVHD typically occurs in the first three months post-transplant, has an incidence rate of between 19 – 66% and can be life threatening in severe cases.

Work over the past several years has investigated the use of biomarkers for non-invasive and predictive assessment of aGVHD risk. Biomarkers can determine whether aGVHD is likely to develop so that clinicians can accurately identify, at an early stage, patients which are at highrisk for severe aGVHD and improve patient outcomes following allogeneic transplants. In August 2018, Viracor Eurofins became the first laboratory to make a predictive aGVHD assay commercially available.

The assay predicts the risk of aGVHD development in those patients who are beginning to display symptoms, those who have previously received aGVHD treatment and even those who are not yet presenting any symptoms indicating the disease. The scope of the test, made available by Eurofins, supplies healthcare providers with actionable data to definitively identify at-risk patients and guide decisions to improve treatment outcomes. High-risk patients can be preemptively treated for aGVHD, while low-risk patients may potentially avoid unnecessary treatment. The aGVHD predictive assay provides a faster, more cost effective and less invasive testing alternative to biopsy, and provides vital information to allow for preemptive intervention, minimising the risk of relapse and infectious complications.

The science behind

The aGVHD predictive assay was developed by Drs. James Ferrara and John Levine (both professors of Pediatrics, Medicine, Hematology and Medical Oncology at The Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai), and validated in conjunction with 17 hematopoietic stem cell transplantation (HSCT) centers to help predict the risk of nonrelapse mortality (NRM) and aGVHD in HSCT patients.

The assay is based on algorithms utilising serum levels of the so-called ST2 and REG3α biomarkers. These algorithms have clinically validated cutoffs that provide actionable insights within 24 hours. Highrisk patients can be preemptively treated for aGVHD by adjusting immunosuppressive drug dosages prior to the onset of clinical disease, while low-risk patients may potentially avoid unnecessary treatment.