Original scientific paper

https://doi.org/10.20471/acc.2026.65.03.10

Serum Albumin, Ferritin, and Zinc as Biomarkers in Oral Chronic Graft-Versus-Host Disease

Maria Radman ; School of Dental Medicine, University of Zagreb, Zagreb, Croatia *
Marinka Mravak Stipetić ; School of Dental Medicine, University of Zagreb, Zagreb, Croatia
Lana Desnica ; Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
Nadira Duraković ; Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
Ana Kerep Zelić ; Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
Radovan Vrhovac ; Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
Steven Živko Pavletić ; National Cancer Institute, Bethesda, Maryland, USA
Dražen Pulanić ; Department of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia

* Corresponding author.

Abstract

Oral chronic graft-versus-host disease (oral cGvHD) is a common, complex, and
multifactorial complication after allogeneic hematopoietic stem cell transplantation
(allo-HSCT). Clinically applicable biomarkers that could support early recognition
and risk stratification still remain insufficiently defined. Therefore, this
study aimed to evaluate the association of selected inflammatory laboratory
parameters with the occurrence and severity of oral cGvHD in comparison to
non-oral cGvHD.
This prospective observational study included 84 allo-HSCT recipients (50%
female), median age 48 years (range 14–68), followed by a multidisciplinary
cGvHD team at University Hospital Centre Zagreb, Croatia. Chronic GvHD was
diagnosed in 69 patients. According to the National Institutes of Health (NIH)
criteria, oral cGvHD was present in 49 patients and 20 patients had systemic
cGvHD without oral involvement. Laboratory markers were compared between
oral cGvHD and the non-oral cGvHD cohort.
Serum albumin levels were significantly lower (38.78 g/L vs 40.10 g/L, P = 0.008),
whereas ferritin levels were significantly higher (928.9 μg/L vs 556.5 μg/L,
P = 0.041) in patients with oral cGvHD compared to those with non-oral cGvHD.
Zinc concentrations were also significantly lower in the oral cGvHD group
(10.8 μmol/L vs 12.1 μmol/L, P = 0.012). These findings indicate that hypoalbuminemia,
hyperferritinemia, and reduced zinc levels are associated with oral
cGvHD and may represent clinically relevant biomarkers of disease severity.
Although larger prospective studies are needed to confirm the association of
these biomarkers with cGvHD severity and clinical applicability, this study provides
new insight into the correlation of zinc and oral cGvHD.

Keywords

Albumin; Ferritin; Zinc; Chronic graft-versus-host disease; Oral chronic graft-versushost disease

Hrčak ID:

351361

URI

https://hrcak.srce.hr/351361

Publication date:

28.9.2026.

Article data in other languages: croatian

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