Risk factors for chronic graft-versus-host disease after anti-thymocyte globulin-based haploidentical hematopoietic stem cell transplantation in acute myeloid leukemia

Abstract

Chronic graft-versus-host disease (cGVHD) is a major complication following unmanipulated haploidentical hematopoietic stem cell transplantation (haplo-HSCT). We aimed to identify the risk factors for cGVHD in patients who underwent anti-thymocyte globulin-based haplo-HSCT for acute myeloid leukemia (n=280). The diagnosis of cGVHD was in accordance with the National Institutes of Health consensus criteria. A total of 169 patients suffered from cGVHD. The patients who had 3 loci mismatched had a higher 8-year incidence of cGVHD (total, 66.0% vs. 53.7%, P=0.031; moderate to severe, 42.4% vs. 30.1%, P=0.036) than the patients who had 1 to 2 loci mismatched. The patients who had maternal donors had a higher 8-year incidence of moderate to severe cGVHD (49.2% vs. 32.9%, P=0.024) compared with the patients who had other donors. The patients who had grades III to IV acute GVHD (aGVHD) had higher 8-year incidence of cGVHD (total, 88.0% vs. 50.4%, P<0.001; moderate to severe, 68.0% vs. 27.0%, P<0.001) compared with the patients without aGVHD. In multivariate analysis, grades III to IV aGVHD was the only independent risk factor for cGVHD. Thus, further interventions should be considered in patients with severe aGVHD to prevent cGVHD.

Keywords

acute graft-versus-host disease / chronic graft-versus-host disease / National Institutes of Health consensus criteria / acute myeloid leukemia / anti-thymocyte globulin

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Acknowledgements

The authors thank Editage for their assistance in editing this manuscript. This work was supported by the Capital’s Funds for Health Improvement and Research (No. 2018-4-4089), the National Natural Science Foundation of China (No. 81873445), the Key Program of the National Natural Science Foundation of China (No. 81530046), the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (No. 81621001), the Science and Technology Project of Guangdong Province of China (No. 2016B030230003), the Project of Health Collaborative Innovation of Guangzhou City (No. 201704020214), Peking University Clinical Scientist Program (No. BMU2019LCKXJ003), and supported by the Fundamental Research Funds for the Central Universities.

Compliance with ethics guidelines

Meng Lv, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Wei Han, Fengrong Wang, Jingzhi Wang, Kaiyan Liu, Xiaojun Huang, and Xiaodong Mo declare no potential financial conflict of interest related to this manuscript. Informed consent was obtained from all patients or their guardians. The study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Peking University People’s Hospital.

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