Ability of MAGIC biomarkers to predict GVHD flares
Akahoshi Y, Spyrou N, Hoepting M, et al. Flares of Acute Graft-Versus-Host Disease (GVHD): A Mount Sinai Acute GVHD International Consortium (MAGIC) Analysis. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2023012091).
Graft-versus-host disease (GVHD) flares often occur after an initial bout of the transplant complication — often with worse outcomes — but researchers say serum biomarkers can predict and possibly avert these events. Investigators conducted a retrospective study involving 968 patients who achieved complete response (CR) or very good partial response (VGPR) within 4 weeks of receiving treatment at one of 23 Mount Sinai Acute GVHD International Consortium (MAGIC) transplant centers. The cumulative incidence of flares within 6 months was 22%, and 41% of those events were classified as Grade III or IV compared with 16% of initial GVHD cases. Flares involved the lower gastrointestinal (LGI) tract 55% of the time compared with 32% LGI involvement during initial GVHD presentation. They also correlated to a significantly higher risk of non-relapse mortality. The research found that early warning of flares, as signaled through Ann Arbor (AA) biomarker scores, could allow clinicians to adjust or terminate immunosuppression. Red flags include higher AA scores at CR/VGPR, early response to initial treatment, and HLA-mismatched unrelated donor.