Researchers Develop “MAGIC Algorithm” to Predict Whether Bone Marrow Transplant Patients May Die From Common Complication
Researchers at Mount Sinai Health System have discovered a way to predict whether blood cancer patients who received a bone marrow transplant will develop graft-versus-host disease, a common and often lethal complication, according to a study published in JCI (The Journal of Clinical Investigation) Insight.
This international study at 11 cancer centers examined blood samples from almost 1,300 bone marrow transplant patients and found that two proteins present in blood drawn a week after a transplant can predict whether a patient will develop a lethal version of graft-versus-host disease, weeks before the disease's symptoms normally occur. Scientists at the Mount Sinai Acute GVHD International Consortium (MAGIC) created an algorithm, dubbed the “MAGIC algorithm,” that determines a patient’s risk of developing the disease by measuring concentrations of these proteins, ST2 and REG3a.
“The MAGIC algorithm gives doctors a roadmap to save many lives in the future. This simple blood test can determine which bone marrow transplant patients are at high risk for a lethal complication before it occurs,” says James L.M. Ferrara, MD, Professor of Pediatrics, Oncological Sciences and Medicine, Hematology and Medical Oncology at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, and Co-director of MAGIC. “It will allow early intervention and potentially save many lives.”
Doctors at Mount Sinai are now designing clinical trials to determine whether immunotherapy drugs, normally used during the onset of graft-versus-host disease, would benefit patients as soon as this new blood test determined they would be at high risk for severe onset of the disease. Researchers believe that if patients receive the drugs once the test is administered, which is well before symptoms develop, they would be spared the full force of the disease, and fewer of them would die.
“This test will make bone marrow transplant safer and more effective for patients because it will guide adjustment of medications to protect against graft-versus-host disease,” says John Levine, MD, MS, Professor of Pediatrics and Medicine, Hematology and Medical Oncology at The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai and Co-director of MAGIC. “If successful, the early use of the drugs would become a standard of care for bone marrow transplant patients.”
Graft-versus-host disease occurs when the bone marrow donor's immune system sees the recipient’s body as foreign and launches an immune response, attacking the recipient's tissue, primarily the skin, liver, and gastrointestinal tract. Between 40 and 60 percent of patients who receive bone marrow transplants later develop severe graft-versus-host disease, and about 40 percent of people who develop the disease die.
The study was supported by grants P01 CA03942 and P30 CA106521 from the National Cancer Institute, an American Cancer Society Clinical Research Professorship (to Dr. Ferrara) and a Doris Duke Charitable Foundation Clinical Research Mentorship.
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."