RUNX1-IT1 and AK026392.1 long non-coding RNAs as early predictors of acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation in acute leukemia

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers curative potential for hematologic malignancies, yet acute graft-versus-host disease (aGVHD) remains a major complication. Long non-coding RNAs (lncRNAs) regulate immune responses and T-cell differentiation, raising interest in their possible role as biomarkers. This study aimed to evaluate the expression of RUNX1-IT1 and AK026392.1 in peripheral CD4⁺ T cells of allo-HSCT recipients with and without aGVHD. Methods: In a case--control design, 30 acute leukemia patients undergoing allo-HSCT were enrolled. Peripheral blood samples were obtained on day +7 post-transplantation. Patients were monitored for 100 days and classified as aGVHD (n=14) or non-GVHD (n=16) according to NIH criteria. Expression levels of RUNX1-IT1 and AK026392.1 were quantified using qRT-PCR and normalized to ABL. Statistical comparisons and ROC curve analyses were performed to assess diagnostic performance. Results: RUNX1-IT1 expression was significantly elevated in the aGVHD group (~14-fold increase, P=0.012) with an AUC of 0.75, sensitivity 64.3%, and specificity 75%. AK026392.1 showed no statistically significant difference (P=0.114) but demonstrated relatively high specificity (87.5%) with an AUC of 0.67. No significant differences in baseline demographic or clinical characteristics were observed between groups. Conclusion: RUNX1-IT1 upregulation in aGVHD patients supports its potential role in Th1-driven immune responses post-allo-HSCT. While AK026392.1 alone was not significant, its high specificity suggests value in combination with RUNX1-IT1 within multi-marker biomarker panels for aGVHD.