OC 32.2 - Growth differentiation factor-15 is associated with risk of major bleeding in patients with cancer: results from a prospective cohort study

Monday, June 24, 2024

09:45 – 10:00 ICT

Room: Ballroom B2

Presenting Author(s)

Cornelia Englisch, MD

PhD Student
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria

Co-Author(s)

Stephan Nopp

Physician
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
Ingrid Pabinger

Professor
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
Florian Moik, MD PhD

Medical University of Graz, Austria
Daniel Steiner

PhD student
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
AS

Angelika M. Starzer

Physician
Division of Oncology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
MF

Monika Fritzer-Szekeres

Professor
Department of Laboratory Medicine, Medical University of Vienna;
Vienna, Wien, Austria
MP

Matthias Preusser

Professor
Division of Oncology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
AB

Anna Berghoff

Professor
Division of Oncology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
Cihan Ay, MD

Professor
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria

Background: Hemostatic imbalances are frequent in patients with cancer. Despite extensive knowledge of venous thromboembolism risk, there is limited understanding of bleeding risk, risk factors, and biomarkers predictive for bleeding in cancer patients. Prior research indicates that growth differentiation factor-15 (GDF-15), a stress-response protein of the transforming growth factor-ß superfamily, holds promise as a predictive biomarker for bleeding risk in various patient populations.

Aims: We aimed to investigate the association between GDF-15 and bleeding risk in a contemporary cohort of patients with cancer initiating systemic anti-cancer therapies.

Methods: Major bleeding (MB) was defined according to the ISTH recommendation. Measurements were performed in serum samples drawn before initiation of anti-cancer treatment with the Elecsys® GDF-15 assay (Roche Diagnostics, Rotkreuz, Switzerland). The association between GDF-15 and MB was analyzed in a Fine and Gray model accounting for all cause-mortality as competing risk.

Results: In total, 792 patients (48% women) were included in this analysis (median age: 62, interquartile range [IQR]: 53-70). At study inclusion, 121 (15.3%) patients received therapeutic anticoagulation and 125 (15.8%) antiplatelet therapy. During a median follow-up of 18 months (IQR: 11-28), 81 patients (10.4%) experienced a MB (12-month cumulative incidence: 8.5%, 95% confidence interval [CI]: 6.5-10.5). The median GDF-15 level was 1863.5 ng/L (IQR: 1061-3490). Elevated GDF-15 levels were significantly associated with an increased risk of MB (SHR per doubling: 1.40 [95% CI: 1.22-1.62]), also when adjusting for potential confounders (figure 1). The cumulative incidence of MB was higher in patients with GDF-15 levels above the median (>1863.5ng/L) than in those with levels below the median (≤1863.5ng/L) (12-month cumulative incidence [95% CI]: 12.8% [9.3-16.2] versus 4.6% [2.4-6.8], p< 0.001, figure 2).

Conclusion(s): In patients with cancer, elevated GDF-15 levels were significantly associated with an increased risk of major bleeding. Therefore, GDF-15 is a promising candidate biomarker for bleeding risk prediction in patients with cancer.