الفهرس 
STEM CELL TRANSPLANTATIONOnly 14 pages are availabe for public view
 |  | from | 199 |  |  |
| | | from | 199 | | |
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).