Among patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT), high levels of vitamin E prior to transplantation appear to predict a lower risk of acute graft-vs-host-disease (GVHD), according to research published in the European Journal of Haematology.

Acute GVHD remains a serious issue among patients undergoing allo-HSCT, contributing significantly to nonrelapse mortality among patients with chronic issues including leukemia and Diamond-Blackfan anemia. Reducing the risk of GVHD remains a concern in this patient population.

Vitamin E, which has been established to display antioxidant properties, may have immunomodulatory effects that could reduce the risk of GVHD in patients undergoing allo-HSCT; however, there has been limited research to confirm whether vitamin E reduces the risk of acute GVHD.

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A team of researchers conducted an observational study to determine whether plasma vitamin E is associated with a reduced risk for GVHD in adults undergoing allo-HSCT with myeloablative conditioning.

Overall, 115 adult patients were included, among whom acute myeloid leukemia (39 patients; 34%), myelodysplastic syndrome (33 patients; 29%), and acute lymphoblastic leukemia (17 patients; 15%) were the most common diagnoses. The median age at transplantation was 50 years (range, 18-71), 56 (49%) patients were women, and the median patient body mass index (BMI) was 24.4; most patients (84; 73%) had a matched unrelated donor.

Vitamin E levels prior to transplantation were inversely linked to grades 2 to 4 acute GVHD (hazard ratio, 0.68 per 10μmol/L; 95% CI, 0.47-0.98), which was also true for results after adjusting for known GVHD risk factors. Compared with patients with less than average vitamin E levels, patients with greater than average levels had a lower cumulative incidence of grade 2 to 4 acute GVHD (46% [95% CI, 33-59]vs 21% [95% CI, 10-32], respectively).

There was no noted association between chronic GVHD incidence and vitamin E levels, though chronic GVHD was not linked with nonrelapse mortality or disease relapse. Post-transplantation vitamin E levels, similarly, were not linked with acute GVHD.


Gjaerde LK, Ostrowski SR, Minculescu L, et al. Vitamin E and acute graft-versus-host disease after myeloablative allogeneic hematopoietic cell transplantation. Eur J Haematol. Published online December 12, 2020. doi:10.1111/ejh.13567