Research Roundup:
U-M study discovers blood test could improve graft-vs.-host diseas e treatment
Elafin shows up
in orange (righthand image) in skin
from a patient with
GVHD.
University of Michigan researchers have identified the
first biomarker of graft-versus-host disease of the skin.
The discovery makes possible a simple blood test that
should solve a treatment dilemma facing doctors with
patients who frequently develop rashes after bone marrow
transplants. The biomarker also makes it possible to
predict who is at greatest risk of dying of GVHD.
GVHD is a frequently fatal complication of allogeneic
bone marrow transplants. These transplants are a common
treatment for children and adults with sickle cell
anemia, leukemia, lymphoma, myeloma and other blood
diseases.
Rashes are very common in patients after bone marrow
transplants, and they may signal the onset of acute
GVHD. Because a firm diagnosis is not easy and the
threat of GVHD is grave, many doctors who suspect a
rash is due to GVHD will prescribe systemic high-dose
steroids to suppress GVHD, which further weakens a
patient's already compromised immune system.
The U-M scientists identified a key biomarker, or
signature protein, of GVHD of the skin called elafin. Elafin
levels can be measured in a blood test to identify which
bone marrow transplant patients with skin rashes actually
have GVHD.
The test, which U-M hopes to make available to
clinicians soon, will make informed treatment possible,
says James Ferrara, M.D., director of the bone marrow
transplant program at U-M.
"This blood test can determine the risk a patient may
have for further complications, and thus physicians will
be able to adjust therapy to the degree of risk, rather
than treating every patient in exactly the same way,"
says Ferrara.
The researchers also found that bone marrow transplant
patients with high levels of elafin were more likely
to die of GVHD than people with low levels. That information
also could guide treatment choices. A method
to evaluate treatment options is badly needed because
transplant patients often require more than 20 different
medications a day, many with very serious side effects.
Read the complete press release.
Tobacco use linked to worse
outcomes in HPV-positive head and neck cancer, U-M study finds
Patients with head and neck cancer linked to high-risk human
papillomavirus, or HPV, have worse outcomes if they are current or
former tobacco users, compared to those who have never used
tobacco, according to a new study from researchers at the University of Michigan
Comprehensive Cancer
Center.
High-risk HPV's are the same viruses that have been associated with cancers of the
uterine cervix.
The researchers suggest that current or former tobacco
users may need a more aggressive treatment regimen than
patients who have never used tobacco.
HPV-positive head and neck cancers tend to be more
responsive to current treatments, and patients overall tend to
have better outcomes than patients with HPV-negative tumors.
But the new study found that current tobacco users with HPVpositive
tumors were five times more likely to have their cancer
recur. Even former smokers had an increased risk of recurrence.
"The side effects of these treatments affect critical functions
such as eating and swallowing. Since the HPV-positive tumors
respond so well to treatments, our research team has been
asking, 'Could we potentially spare patients some of these
side effects while maintaining good outcomes if we reduce the
doses given?' If we decide to reduce intensity of treatment,
our study shows we will want to take tobacco use into account.
Any smoking or tobacco use increases the risk of recurrence
or a second primary cancer," says senior study author Thomas
Carey, Ph.D., co-director of the Head and Neck Oncology
Program at the U-M Comprehensive Cancer Center.
Researchers from U-M's multidisciplinary head and neck
oncology program are planning a clinical trial to look at reducing
treatment intensity for low-risk patients -- those whose
tumors express certain markers, including HPV, and who are
not tobacco users. The trial is expected to begin this spring.
Read the complete press release.
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