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Turk J Haematol. 2019 Aug 29. doi: 10.4274/tjh.galenos.2019.2019.0139. [Epub ahead of print]

Predictive values of early suppression of tumorigenicity 2 for acute GVHD and transplant-related complications after allogeneic stem cell transplantation: prospective observational study

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Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine
Department of Hematology, Yokohama City University Medical Center



A soluble form of suppression of tumorigenicity 2 (ST2) has emerged as a biomarker for acute graft-versus-host disease (GVHD) and non-relapse mortality (NRM). We prospectively monitored soluble ST2 levels during the early phase of hematopoietic stem cell transplantation (HSCT) and evaluated the clinical association with transplant-related complications including acute GVHD.

Materials and methods:

Thirty-two adult Japanese patients who received first allogeneic HSCT were enrolled in this study. Soluble ST2 were measured at fixed time points (pre-conditioning, day 0, day 14, day 21, and day 28).


The median age was 50.5 years (range: 16-66). With a median follow-up of 21.5 months (range: 0.9-35.4), 9 patients developed grade II–IV acute GVHD. Median soluble ST2 levels on the day of HSCT were higher than baseline and reached the maximum value (92.7 ng/mL (range: 0-419.7)) on day 21 after HSCT. The optimal cut-off value of soluble ST2 on day 14 for predicting grade II–IV acute GVHD was determined as 100 ng/mL by the ROC analysis. The cumulative incidence of acute GVHD was 56.7% and 16.5% in the high and low-ST2 group, respectively (P < 0.01). Multivariate analyses showed that high-ST2 levels at day 14 were associated with a higher incidence of acute GVHD (hazard ratio: 9.35, 95% confidence interval: 2.92-30.0, P < 0.01). The cumulative incidence of NRM was increased in the high-sST2 group (33% vs. 0%, P < 0.01), but all the patients died of non-GVHD complications. Among 6 patients in high-ST2 group without grade II–IV GVHD, 5 patients developed veno-occlusive disease (VOD) and one overlapped thrombotic microangiopathy (TMA).


The early assessment of ST2 after HSCT yielded predictive values for the onset of acute GVHD and other transplant-related complications including VOD and TMA.

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