Some posters really do talk nonsense…they are just armchair...

Some posters really do talk nonsense…they are just armchair experts who obsfucate to their heart‘s content for reasons and motives which should be carefully examined.

Here is the evidence, freely available for those that want to look and educate themselves. Sorry to cut and paste, but the references to ST2 which is the biomarker used in MAP scoring is backed up by extensive meta data…to argue otherwise is disingenuous in my opinion. Some excellent studies referenced below provide some detailed information.


”ST2 is the most validated biomarker for aGVHD and has been tested for several clinical outcomes.ST2 as a predictive marker. ST2 was identified and validated as a biomarker for the risk of therapy-resistant aGVHD and death in two independent cohorts from two centres. Using state-of-the art tandem mass spectrometry proteomics, a comparison was made between plasma obtained a median of 16 days after therapy initiation from patients with a complete response by day 28, and patients with progressive aGVHD during therapy. Of the 12 lead candidate markers, ST2 was as significant as the other 12 markers in a panel for predicting resistance to aGVHD therapy and subsequent death without relapse. As compared with patients with low ST2 values at therapy initiation, patients with high ST2 values were 2·3 times as likely to have treatment-resistant GVHD (95%, 1·5–3·6) and 3·7 times as likely to die within six months after therapy (95% CI, 2·3–5·9). Furthermore, for the first time for aGVHD markers, ST2 was predictive regardless of the clinical onset aGVHD grade (Vander Lugt et al., 2013). Since then, ST2 has been validated in large cohorts totaling >1000 HCT patients (Levine et al., 2015). It has now been implemented in several clinical trials, including the Blood and Marrow Transplant Clinical Trials Network (BMTCTN) study 1501 (NCT02806947). This was a randomised phase II multicentre open-label study, evaluating sirolimus and prednisone in patients with Minnesota standard-risk and low-risk biomarker-confirmed aGVHD, which shows that sirolimus (a steroid-free treatment) provides similar day 28 complete/partial response rates as prednisone in initial therapy of standard-risk acute GVHD (Pidala et al., 2020). This means that biomarkers already help the clinician decide on a less toxic aGVHD treatment. What more? Trials with high-risk biomarkers using intensified treatment are also under development for patients with newly diagnosed aGVHD.ST2 as a prognostic marker. Plasma ST2 values measured early post-transplantation before the clinical signs of aGVHD were associated with six-month mortality without relapse, and improved risk stratification for death without relapse after transplantation (Vander Lugt et al., 2013). This has been further validated in several cohorts totaling ~3000 HCT patients (McDonald et al., 2015; Abu Zaid et al., 2017; Hartwell et al., 2017). Furthermore, ST2 as a prognostic marker has been validated in different HCT settings: i) a cohort of patients receiving cyclophosphamide-fludarabine non-myeloablative HCT (Nelson et al., 2014), ii) a cohort of patients receiving cord blood allo-HCT (Ponce et al., 2015), iii) three cohorts of patients treated with PTCy following HLA-haploidentical or HLA-matched-related or -unrelated allo-HCT (Kanakry et al., 2017), and d) a cohort of patients in a multicentre phase 3 trial with uniform clinical and transplant characteristics post-allo-HCT (Abu Zaid et al., 2017). However, although ST2 was validated on large retrospective sets, it has not yet been implemented prospectively into pre-emptive treatment, as commented on in Clinical Chemistry(Paczesny, 2017).ST2 as a response to treatment marker. ST2 in combination with TIM3 tested 14 days post-prednisone, and ST2 in combination with Reg3α tested seven days post-steroids, showed convincing statistical values comparing responders versus non-responders (McDonald et al., 2017; Major-Monfried et al., 2018).”



“These assay analytical performance characteristics are summarised in Table I. After the nine ‘steps’ of assay/method validation listed in this table, the tests meet all of the requirements needed for CLIA-88, the NYSDOH CLEP Standards, and the quality standards of the College of American Pathologists. Only a few GVHD biomarkers have followed this rigorous validation, one of them being the ST2 ELISA assay.”


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415515/

Volume 3, Issue 23, 10 December 2019, Pages 4034-4042TRANSPLANTATIONThe MAGIC algorithm probability is a validated response biomarker of treatment of acute graft-versus-host diseaseAuthor links open overlay panelHrishikesh K. Srinagesh 1, Umut Özbek 2, Urvi Kapoor 1, Francis Ayuk 3, Mina Aziz 1, Kaitlyn Ben-David 1, Hannah K. Choe 4, Zachariah DeFilipp 5, Aaron Etra 1, Stephan A. Grupp 6, Matthew J. Hartwell 1, Elizabeth O. Hexner 7, William J. Hogan 8, Alexander B. Karol 1, Stelios Kasikis 1, Carrie L. Kitko 9, Steven Kowalyk 1, Jung-Yi Lin 2, Hannah Major-Monfried 1, Stephan Mielke 10, 11, Pietro Merli 12, George Morales 1, Rainer Ordemann 13, Michael A. Pulsipher 14, Muna Qayed 15, Pavan Reddy 16, Ran Reshef 17, Wolf Rösler 18, Karamjeet S. Sandhu 19, Tal Schechter 20, Jay Shah 1, Keith Sigel 1, Daniela Weber 21, Matthias Wölfl 22, Kitsada Wudhikarn 23, Rachel Young 1, John E. Levine 1, *, James L.M. Ferrara 1,


*,https://www.sciencedirect.com/science/article/pii/S2473952920317365