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Biol Blood Marrow Transplant. 2014 Jul;20(7):1056-9. doi: 10.1016/j.bbmt.2014.03.012. Epub 2014 Mar 15.

Relative defects in mucosal immunity predict acute graft-versus-host disease.

Author information

1
Division of Pediatric Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
2
Division of Pediatric Hematology-Oncology, Aflac Cancer and Blood Disorders Center, Emory University/Children's Healthcare of Atlanta, Atlanta, Georgia.
3
Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
4
Division of Pediatric Hematology-Oncology, Aflac Cancer and Blood Disorders Center, Emory University/Children's Healthcare of Atlanta, Atlanta, Georgia. Electronic address: jth2148@columbia.edu.

Abstract

Impairment of gut mucosal immunity by the transplant process could facilitate translocation of commensal bacteria and thereby augment the graft-versus-host response. To begin to assess the influence of gut mucosal immunity on the development of acute graft-versus-host disease (GVHD), we conducted a prospective study in 24 pediatric allogeneic hematopoietic cell transplant recipients, assessing 4 fecal markers of mucosal immunity: calprotectin, soluble CD8 (sCD8), soluble intracellular adhesion molecule 1, and β-defensin-2. Stool samples were collected prospectively on transplant days 0, +5, +10, and +15 and analyzed by ELISA. Lower levels on day +5 (calprotectin and β-defensin-2) and day +10 (calprotectin, β-defensin-2, and sCD8) were associated with subsequent acute GVHD. The most striking difference was with calprotectin on day +10. Patients with levels below 424 mg/kg had an incidence of 77.8%, whereas those with levels above this threshold had a cumulative incidence of 0% (P = .002). Relative defects in gut mucosal immunity may be important in the pathogenesis of acute GVHD.

KEYWORDS:

Allogeneic hematopoietic cell transplantation; Fecal biomarkers; Graft-versus-host disease; Gut mucosal immunity

PMID:
24641826
DOI:
10.1016/j.bbmt.2014.03.012
[Indexed for MEDLINE]
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