By Elodie Vaz | Published on February 18, 2026 | 3 min read
Each year,
thousands of patients undergo stem cell or bone marrow transplantation, often
the only curative option for hematologic malignancies. While the acute phase of
transplantation is now better controlled, late complications remain a major
challenge. Among them, chronic graft-versus-host disease (cGVHD) remains one of
the leading causes of morbidity and mortality after transplantation.
cGVHD is an
immune-mediated condition in which donor immune cells attack the recipient’s
healthy tissues. It can affect multiple organs—including the skin, eyes, mouth,
joints, and lungs—and may lead to severe functional impairment or death. In
most cases, the disease develops silently, well before the first clinical
symptoms appear.
Anticipating
the irreversible
Researchers
at the MUSC Hollings Cancer Center sought to identify these early, invisible
warning signals. Their objective was to predict the future risk of cGVHD and
transplant-related mortality before any clinical manifestation.
“By the
time chronic GVHD is diagnosed, the disease has often been progressing for
months, silently affecting the body,” explained Dr. Sophie Paczesny, co-leader
of the Cancer Biology and Immunology Research Program at Hollings and co-author
of the study, in a press release. “We wanted to know whether it was possible to
detect early warning signs before patients even begin to feel ill.” The
findings were published on February 16 in the Journal of Clinical
Investigation.
AI,
biomarkers, and clinical data
The study
analyzed 1,310 patients from four multicenter studies, all of whom had
undergone stem cell or bone marrow transplantation. Blood samples collected
between 90 and 100 days post-transplant were analyzed to measure seven
immune-related proteins associated with inflammation, immune activation, and
tissue remodeling.
These
biomarkers were combined with nine clinical variables—such as age, transplant
type, underlying disease, and prior complications—drawn from the Center for
International Blood and Marrow Transplant Research registry.
Several
machine learning models were tested. The best-performing model, based on
Bayesian additive regression trees, served as the foundation for the BIOPREVENT
tool, designed to estimate future risk of cGVHD and transplant-related
mortality.
A signal
before disease onset
Models
integrating both biomarkers and clinical data consistently outperformed
clinical-only models, particularly in predicting transplant-related mortality.
The tool was subsequently validated in an independent cohort, confirming its
robustness.
BIOPREVENT
stratifies patients into low- and high-risk groups, with clearly distinct
clinical trajectories up to 18 months post-transplant. Notably, some biomarkers
were specifically associated with mortality, while others were more strongly
predictive of cGVHD onset, suggesting partially distinct biological mechanisms.
To
facilitate adoption, BIOPREVENT was developed into a free web-based
application, allowing clinicians to input biological and clinical data to
obtain a personalized risk estimate.
“It was
important to us that this project not remain a theoretical model,” Dr. Paczesny
emphasized. “Making BIOPREVENT freely accessible allows researchers and
clinicians to test it and improve patient management.” At present, the tool is
intended for research and risk assessment purposes and does not directly guide
therapeutic decisions.
Toward
precision transplantation
This study
represents a key step toward precision medicine in transplantation, based on
integrating biological and clinical data. Clinical trials will be necessary to
determine whether enhanced surveillance or early interventions in high-risk
patients can truly improve outcomes.
“It is not
about replacing clinical judgment,” Dr. Paczesny concluded, “but about
providing better information earlier so clinicians can make more informed
decisions.” Ultimately, BIOPREVENT could transform post-transplant
follow-up—shifting from a reactive approach to complications toward a proactive
approach to risk.
Read
next: Will biomarkers save patients with
refractory testicular germ cell tumors?About the author – Elodie Vaz
Health journalist, graduated from the CFPJ in 2023
Élodie explores the marks that illnesses leave on bodies and, more broadly, on human life. A state-registered nurse since 2010, she spent twelve years at patients’ bedsides before trading her stethoscope for a notebook. She now examines the connections between environment and health, convinced that the vitality of life cannot be reduced to that of humans alone. 
