When we teach our students about transplants, we emphasize the seriousness of graft versus host disease (GVHD). This complication is the major cause of death in patients who receive bone marrow transplants. GVHD begins when the immune cells in the donor bone marrow identify the cells of the recipient as foreign and stimulate an aggressive immune response. Early symptoms of GVHD include a skin rash, but can progress to organ rejection syndrome and 30-40% fatality. Treatment includes high doses of steroids, often begun without a conclusive diagnosis of GVHD. The high dose steroids can increase the risk of infection and/or lead to a relapse in cancer patients. So the use of these high dose steroids is often an issue of concern when the diagnosis of GVHD is inconclusive.
Recent research emphasizes that we may need to include an explanation of elafin levels in our teaching related to GVHD. A group of researchers led by pediatric oncologist James Ferrara of the University of Michigan, Ann Arbor, obtained weekly plasma samples from patients who had received donated bone marrow. They examined levels of elafin (an anti-inflammatory protein produced by the body in response to skin GVHD) in 10 patients who had developed GVHD and in 20 patients who had no symptoms of GVHD. They found that elafin levels in patients developing skin GVHD were, on average, 3 times higher than in the other group. The researchers then followed the long-term survival of 159 patients who had GVHD. They compared outcomes for persons with higher than average levels of elafin to those with lower than average levels. After 1 year, 3 times as many patients in the high-elafin group had died from GVHD and associated complications when compared to the group with low-elafin levels.
Ferrara emphasized that the ability to detect GVHD by monitoring plasma elafin levels could lead to more rapid and accurate treatment for this life-threatening condition. So teaching our students the need for monitoring the plasma levels of elafin in transplant patients could allow targeted treatment even before the development of the associated skin rash.
Source: Wogan, T. January 6, 2010. Blood Test developed for deadly transplant complication. ScienceNOW Daily News. Available athttp://sciencenow.sciencemag.org/cgi/content/full/2010/106/4. Accessed on January 18, 2010.
Submitted by: Robin Pattillo, PhD, RN, News Editor at[email protected].