Follistatin is an angiogenic factor elevated in the circulation after
allogeneic hematopoietic cell transplantation (HCT). Elevations in follistatin
plasma concentrations are associated with the onset of and poor survival after
acute graft versus host disease (aGVHD). Using data from the Blood and Marrow
Transplant Clinical Trials Network 0402 study (n=247), we sought to
further quantify the longitudinal associations between plasma follistatin levels
in transplant recipients, as well as baseline HCT donor follistatin levels, and
allogeneic HCT outcomes. Higher recipient baseline follistatin levels were
predictive of development of aGVHD (P=0.04). High donor
follistatin levels were also associated with the incidence of aGVHD
(P<0.01). Elevated follistatin levels on day 28 were
associated with the onset of grade II–IV aGVHD prior to day 28, higher
one-year non-relapse mortality, (NRM), and lower overall survival (OS). In
multivariate analyses, individuals with follistatin levels >1088 pg/mL at day
28 had a four-fold increased risk for NRM (RR=4.3, 95% CI
1.9–9.9, P<0.01) and a nearly three-fold increased
overall risk for mortality (RR=2.8, 95% CI 1.5–5.2,
P<0.01). Given the multiple roles of follistatin in
tissue inflammation and repair, and the confirmation that this biomarker is
predictive of important HCT outcomes, the pathobiology of these relationships
need further study.