Abstract
The current practice for diagnosing graft versus host disease (GVHD) includes clinical or endoscopic evaluation of the patient. Clinical diagnosis is limited by an overlapping symptomatic spectrum with infectious causes, a common scenario in the post-transplant setting where an invasive procedure, such as endoscopy, is often impractical. We, therefore, evaluated the role of fecal calprotectin as a diagnostic as well as a prognostic biomarker for gastrointestinal GVHD (GI-GVHD) occurrence and severity in the post-hematopoietic transplant population. Following Prisma guidelines, we performed a systematic search of articles published after 2004 using the PubMed, Embase, Cochrane Library, and Web of Science databases. After a detailed screening, 10 studies involving a total of 494 patients were included. In the cohorts comparing median fecal calprotectin (mFC) level in GI-GVHD vs. non-GI-GVHD patients, the results indicated an increase in the mFC level in patients with GI-GVHD when compared to non-GI-GVHD patients. Similarly, an increase in the mFC level was seen in accordance with the severity of the disease. Moreover, corticosteroid-resistant patients had a higher mFC level as compared to corticosteroid-sensitive patients. Our study indicates that the mFC level can be used for diagnosing as well as predicting the treatment response to GI-GVHD. However, future randomized prospective trials involving larger populations are needed to further explore its significance.
Highlights
BackgroundGraft versus host disease (GVHD) is the most important complication after allogeneic hematopoietic stem cell transplantation (HSCT) and a leading cause of morbidity and mortality [1,2]
The main aim of our analysis is to study the published literature on the role of fecal calprotectin as a diagnostic and prognostic biomarker in patients with GI-graft versus host disease (GVHD) after allogeneic HSCT
The incidence of GVHD is 50% to 70% and it is an important cause of morbidity and mortality after allogeneic HSCT [1]
Summary
BackgroundGraft versus host disease (GVHD) is the most important complication after allogeneic hematopoietic stem cell transplantation (HSCT) and a leading cause of morbidity and mortality [1,2]. A heterodimer of two S100 family proteins (A8 and A9), is secreted by activated macrophages and neutrophils and acts by binding to endothelial cells, thereby inducing leukocyte recruitment and the secretion of pro-inflammatory cytokines [6]. It has antibacterial and antifungal activities and induces apoptosis upon neutrophilic activation in cell cultures. Its level in feces is found to be six times higher than in plasma, and it remains stable in stool for more than seven days at a different temperature, thereby showing resistance to proteolysis [2,3,6]
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