Grant: Project Grant

Hematopoietic Stem Cell Transplantation (HSCT) is a lifesaving treatment for Canadians with incurable blood cancers and other fatal bone marrow associated diseases. One of the major, potentially lifelong complications of HSCT is chronic graft-versus-host disease (cGvHD) where the donated blood and immune system from the donor (graft) rejects the recipient 's (host) organs sometimes causing lifelong debilitation or even death due to irreversible scarring or fibrosis. Even after over 40 years of curing thousands of Canadians we still don't understand the very complex immune mechanisms of cGvHD resulting in doctors still using a "hit or miss" use of drugs to treat cGvHD. The only way we improve treatment for patients with cGvHD is to have tests or biomarkers to guide our understanding and increase the success of treatment. In 2012 we developed a Canadian based cGvHD biomarker network focused on developing blood-based biomarkers test to help us diagnose and predict which HSCT patients might develop cGvHD after their transplant. We have now completed 3 large biomarker studies enrolling over 900 children and adults with a very thorough analysis of their immune system in their blood. Using this large biomarker database we have also been able to see if we can better understand the biology of cGvHD. We are the first in the world to find that cGvHD is not one disease but in fact 3 separate diseases. Using this recent knowledge, we now hope to use it to determine which drugs work best for the different cGvHD types. We will also perform additional analyses using an AI statistical approach to see if we can develop cGvHD marker combinations to guide which is the best treatment for each patient that develops cGvHD. This study will tap into the previous study samples and enroll 60 children and 60 adult HSCT patients in the US and Canada and see if we can determine whether the cGvHD subtypes will help us determine the best treatment for a particular patient with chronic GvHD.