Soluble ST2 as a Predictive Biomarker for Acute Graft-Versus-Host Disease Post -Allogeneic Stem Cell Transplantation

Acute graft-versus-host disease (aGVHD) remains a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Identifying reliable biomarkers for early prediction of aGVHD could enable timely interventions and improve patient outcomes.

This study aims to assess whether levels of specific cytokines can serve as predictive markers for the onset and severity of aGVHD.

Plasma levels of IL-6, IFN-γ, TNF-α, sST2, CD25, and REG3α were measured via ELISA in 50 allo-HSCT patients (20 with aGVHD and 30 without aGVHD) on Days +7, +14, and +21 post - transplantation. Receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were used to assess the predictive performance of these biomarkers.

Among the six biomarkers analyzed, sST2 demonstrated the highest predictive accuracy for aGVHD. Elevated sST2 levels at Days +14 and +21 posttransplantation significantly correlated with aGVHD occurrence (AUC = 0.7092 at Day +21) and gastrointestinal aGVHD (AUC = 0.8007 at Day +14). sST2 also showed strong predictive performance for severe aGVHD (Grade II-IV), with AUC values of 0.8125 at Day +7 and 0.8021 at Day +14. Other biomarkers, including IL-6, REG3α, CD25, and TNF-α, exhibited dynamic changes but lacked robust predictive value for aGVHD onset or severity. These findings support sST2 as a promising biomarker for early risk stratification of aGVHD.

SST2 is a promising biomarker for the early prediction of aGVHD, offering potential for guiding proactive therapeutic strategies in allo-HSCT patients.