Growth differentiation factor-15 is a new biomarker for survival and renal outcomes in light chain amyloidosis

Efstathios Kastritis, Ioannis Papassotiriou, Giampaolo Merlini, Paolo Milani, Evangelos Terpos, Marco Basset, Athanasios Akalestos, Francesca Russo, Erasmia Psimenou, Filia Apostolakou, Maria Roussou, Maria Gavriatopoulou, Evangelos Eleutherakis-Papaiakovou, Despina Fotiou, Dimitrios C. Ziogas, Elektra Papadopoulou, Constantinos Pamboucas, Meletios A. Dimopoulos, Giovanni Palladini

Research output: Contribution to journalArticle

Abstract

Growth differentiation factor-15 (GDF-15) improves prognostication in patients with cardiovascular disorders in addition to conventional cardiac markers (N-terminal pro B-type natriuretic peptide [NT-proBNP], troponins [Tns]) and has shown prognostic value in patients with renal diseases. In patients with light chain (AL) amyloidosis, cardiac involvement is the major determinant of prognosis, and cardiac markers define prognosis, whereas biomarkers of renal involvement stratify renal risk. We explored the prognostic importance of serum level of GDF-15 in patients with AL amyloidosis in 2 independent cohorts. The prognostic value of GDF-15 level was initially evaluated in a cohort of 107 consecutive previously untreated patients with AL amyloidosis from Athens, Greece, and was then validated in a second cohort of 202 consecutive previously untreated patients from Pavia, Italy. High GDF-15 level was associated with a higher risk of early death and poor overall survival independently of NT-proBNP and high-sensitivity TnT (hsTnT) or hsTnI levels. At the 6-month landmark, reduction of GDF-15 level ‡25% was associated with improved outcome. GDF-15 level ‡4000 pg/mL was associated with a high risk of progression to dialysis, independently of renal risk defined by estimated glomerular filtration rate and proteinuria, in both cohorts; failure to reduce GDF-15 below this level was associated with increased risk at either the 3- or 6-month landmark, independently of the established renal response or progression criteria. In conclusion, GDF-15 has prognostic implications for different outcomes in patients with AL and adds prognostic information independent of that provided by cardiac and renal risk biomarkers. (Blood. 2018;131(14):1568-1575)

Original languageEnglish
Pages (from-to)1568-1575
Number of pages8
JournalBlood
Volume131
Issue number14
DOIs
Publication statusPublished - Apr 5 2018

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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  • Cite this

    Kastritis, E., Papassotiriou, I., Merlini, G., Milani, P., Terpos, E., Basset, M., Akalestos, A., Russo, F., Psimenou, E., Apostolakou, F., Roussou, M., Gavriatopoulou, M., Eleutherakis-Papaiakovou, E., Fotiou, D., Ziogas, D. C., Papadopoulou, E., Pamboucas, C., Dimopoulos, M. A., & Palladini, G. (2018). Growth differentiation factor-15 is a new biomarker for survival and renal outcomes in light chain amyloidosis. Blood, 131(14), 1568-1575. https://doi.org/10.1182/blood-2017-12-819904