CHRONIC Graft-versus-Host Disease biomarkers including von Willebrand factor and factor VIII demonstrated potential diagnostic and disease activity value in patients with chronic Graft-versus-Host Disease following allogeneic haematopoietic stem cell transplantation.
Chronic Graft-versus-Host Disease Biomarkers Evaluated
The prospective study investigated biomarkers in 83 patients with chronic Graft-versus-Host Disease and 39 recipients of allogeneic haematopoietic stem cell transplantation without chronic Graft-versus-Host Disease. Researchers assessed von Willebrand factor antigen activity, von Willebrand factor activity, and factor VIII activity to determine their relationship with disease presence and severity.
All three biomarkers were significantly elevated in patients with chronic Graft-versus-Host Disease compared with transplant recipients without the condition: p<0.001. The highest biomarker levels were identified in patients with active disease, suggesting a strong association between endothelial activation, inflammation, and disease activity.
Higher von Willebrand factor antigen and von Willebrand factor activity levels were particularly associated with liver and oral manifestations of chronic Graft-versus-Host Disease. These findings indicate that biomarker elevation may reflect organ specific disease involvement in addition to overall inflammatory burden.
Predictors Of Elevated Biomarker Levels
Multivariate analysis identified lower albumin as the strongest predictor of elevated von Willebrand factor antigen levels: R²=0.576, and elevated von Willebrand factor activity: R²=0.540. Additional predictors included older age, increased lactate dehydrogenase levels, and a higher number of affected organs.
For elevated factor VIII activity, systemic immunosuppressive therapy emerged as the primary predictor: R²=0.247. Researchers also conducted longitudinal analyses, which demonstrated declining biomarker levels in patients achieving remission, while persistently elevated levels were observed in those with active chronic Graft-versus-Host Disease.
These findings suggest that the biomarkers may provide clinically relevant information regarding treatment response and ongoing disease activity over time.
Diagnostic Potential Demonstrated
Receiver operating characteristic analysis demonstrated potential utility for early diagnosis of chronic Graft-versus-Host Disease. Von Willebrand factor antigen levels above 246.3% achieved an area under the curve of 0.733, while von Willebrand factor activity levels above 271.4% achieved an area under the curve of 0.728.
The investigators concluded that von Willebrand factor and factor VIII may represent novel chronic Graft-versus-Host Disease biomarkers for both diagnosis and disease activity assessment. However, the authors noted that additional validation in independent cohorts is still required before broader clinical implementation.
Reference
Lelas A et al. Von Willebrand factor and factor VIII as potential biomarkers for diagnosis and disease monitoring in chronic graft-versus-host disease. Bone Marrow Transplant. 2026; 10.1038/s41409-026-02903-3.
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