George, L.Mahabal, G.Mohanan, E.Balasubramanian, P.Peter, D.Pulimood, S.Lakshmi, K.Jeyaseelan, L.Abraham, A.Srivastava, A.Mathews, V.George, B.2021-08-302021-08-302021Clinical and Experimental Dermatology, 2021; 46(8):1482-14870307-69381365-2230http://hdl.handle.net/2440/131737First published: 03 June 2021Background: Acute cutaneous graft-versus-host disease (acGVHD) following haematopoietic stem cell transplant (HSCT) is common but difficult to distinguish from other causes of rash. Plasma elafin has been proposed as a diagnostic and prognostic biomarker of skin GVHD. Aim: To evaluate the role of plasma elafin as a biomarker in acGVHD in an Indian population. Methods: Plasma elafin was evaluated in a prospective study of HSCT recipients, conducted over 2 years, taking measurements at baseline and at onset of skin rash after HSCT. Patients were categorized into those with GVHD rash, those with non-GVHD rash and those with no rash and the three groups were compared. Results: Two hundred and sixty-one patients with a median age of 16 years (range 1–61 years) and a male predominance (175 : 86 M/F) underwent HSCT during the study period: 56 patients in the GVHD group, 49 in the non-GVHD group and 156 in the no-rash group. The median baseline elafin was similar in all three groups. At the onset of rash, median elafin level was similar between GVHD and non-GVHD rash (34 549 vs. 32 077 pg/mL; P = 0.58) and between GVHD and no rash (34 549 vs. 26 197 pg/mL; P = 0.08). A rise in elafin from baseline was significantly different between GVHD and no rash (P < 0.001) but not between GVHD and non-GVHD rash (P = 0.44). Conclusion: The utility of plasma elafin as a biomarker of skin GVHD is very limited. Plasma elafin, although elevated in cutaneous GVHD, is not helpful in distinguishing between GVHD rash and other causes of rash following HSCT.en© 2021 British Association of DermatologistHumansExanthemaGraft vs Host DiseaseDiagnosis, DifferentialHematopoietic Stem Cell TransplantationAdolescentAdultMiddle AgedChildChild, PreschoolInfantFemaleMaleElafinYoung AdultBiomarkersJournal article100004508210.1111/ced.147852-s2.0-85110216347583361