In a study published in Human Cell, researchers reported 3 novel risk factors associated with the severity of chronic graft‐versus‐host disease (cGVHD) development after allogeneic stem cell transplantation (alloSCT): the number of CD19-positive (CD19+)– and CD3-positive (CD3+)–infused cells in the graft and the presence of patient human leukocyte antigen (HLA) antibodies before transplantation.

The investigators analyzed data from a consecutive series of patients with acute myelogenous leukemia/myelodysplastic syndrome (AML/MDS) who received alloSCT with nonmyeloablative conditioning to identify risk factors associated with the severity of cGVHD. Potential risk factors included were transfusions before transplantation, presence of HLA antibodies, composition of the graft (CD3+, CD19+, CD34+ cells), sibling or matched unrelated donor, female donor to male recipient, cytomegalovirus serology, and the development of acute GVHD.

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The study cohort included 98 patients, of whom 85 had AML and 13 had MDS. Median patient and donor ages were 57 years (range, 24-74) and 45 years (range, 19-71), respectively. Of the 67% of patients in whom cGVHD developed, 42% experienced mild cGVHD and 58% experienced moderate-to-severe cGVHD. Median time from transplantation to onset of both mild and moderate to severe cGVHD was 208 days.

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In multivariate analysis, the investigators found that the number of CD19+ (hazard ratio [HR], 2.79; 95% CI, 1.35-5.74; P <.01) and CD3+ (HR, 2.18; 95% CI, 1.04-4.59; P =.04) cells in the graft as well as presence of patient HLA antibodies prior to transplantation (HR, 2.34; 95% CI, 1.11-4.95; P =.03) were significantly associated with the development of moderate to severe cGVHD.

However, the researchers cautioned that their findings “should be confirmed in a larger multicenter cohort of patients to confirm clinical significance.”


1.     Kok LMC, Bungener L, de Bock GH, et al. Risk factors associated with the development of moderate to severe chronic graft-versus-host disease after non-myeloablative conditioning allogeneic stem cell transplantation in patients with AML or MDS [published online November 15, 2019]. Hum Cell. doi:10.1007/s13577-019-00297-7