Fecal calprotectin demonstrated potential as a biomarker for predicting, diagnosing, and monitoring gastrointestinal graft versus host disease following allogeneic haematopoietic stem cell transplantation, according to findings from a prospective observational study involving 165 adult recipients.
Fecal Calprotectin Identifies Patients at Risk
Gastrointestinal graft versus host disease remains one of the most significant complications after allogeneic haematopoietic stem cell transplantation and often requires invasive endoscopic assessment to establish a diagnosis. Researchers evaluated the role of fecal calprotectin as a non-invasive marker of intestinal inflammation by measuring levels at multiple time points following transplantation and comparing results with clinical, endoscopic, and histological findings.
Among the 165 patients included in the study, gastrointestinal graft versus host disease developed in 52.7%, with histological confirmation achieved in 90.3% of cases. The predictive performance of fecal calprotectin varied according to timing. On day 7 after transplantation, fecal calprotectin showed no predictive value: area under the curve (AUC): 0.50. However, accuracy improved on day 14: AUC: 0.69 and further increased by day 21: AUC: 0.77.
The optimal day 21 threshold was identified as 52.5 µg/g, providing: sensitivity 75%; specificity 87%. These findings suggest fecal calprotectin may help identify patients at increased risk of developing gastrointestinal graft versus host disease before clinical diagnosis.
Association With Endoscopic Disease Activity
At the onset of gastrointestinal graft versus host disease, median fecal calprotectin levels reached 120 µg/g. Investigators found a significant correlation between fecal calprotectin concentrations and endoscopic severity: r=0.31; p=0.02.
In contrast, fecal calprotectin levels did not correlate with either clinical grading or histological severity. These data suggest the biomarker may more closely reflect mucosal inflammatory activity observed during endoscopic assessment rather than broader disease classifications.
Monitoring Response to Treatment
Fecal calprotectin levels also appeared useful for monitoring treatment response. Seven days after therapy initiation, median concentrations declined significantly from 120 µg/g to 51.5 µg/g: p=0.04.
Although concurrent infections were associated with elevated fecal calprotectin levels, the biomarker retained its ability to distinguish patients with gastrointestinal graft versus host disease. The investigators concluded that fecal calprotectin functions as a dynamic marker across multiple stages of disease management. However, because elevations may occur in other inflammatory conditions, results should be interpreted alongside clinical findings and other diagnostic assessments.
Reference
Piñero-Pérez C et al. Fecal calprotectin as a biomarker for the diagnosis of gastrointestinal graft-versus-host disease following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplantation. 2026; https://doi.org/10.1038/s41409-026-02934-w.
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