Both genetic and clinical factors predict the development of graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.
BACKGROUND
Graft-versus-host disease is the main complication of hematopoietic stem cell transplantation. Recently, pro- and anti-inflammatory cytokines and mismatches of minor histocompatibility antigens between HLA-identical sibling donor/recipient pairs have been implicated in the development of acute graft-versus-host disease. It is not known, however, whether these factors are independent of other clinically recognized risk factors such as age and disease stage.


METHODS
In this study, we searched for risk factors of acute graft-versus-host disease using multivariate Cox regression analysis in 100 consecutive patients who underwent allogeneic stem cell transplantation from an HLA-identical sibling donor. Eight polymorphisms from five different cytokine genes were studied (tumor necrosis factor alpha, tumor necrosis factor beta, interleukin (IL) 6, IL-10, and interferon gamma). Mismatches for the minor histocompatibility antigen HA-1 were searched in HLA-A*0201 individuals. In addition to these new risk factors, patient, donor, disease, and transplant risk factors were analyzed by multivariate analysis using the Cox proportional hazards model.


RESULTS
Acute graft-versus-host disease was independently associated with IL-10 gene polymorphisms both from the recipient (relative risk=7.9, P<0.0001) and the donor (relative risk=3.5, P=0.02), a donor's positive serology for cytomegalovirus, and HA-1 mismatches in HLA-A*0201 individuals (relative risk=2.8, P=0.05). Chronic graft-versus-host disease was independently associated with IL-6 gene polymorphism from the recipient (relative risk=4.2, P=0.02), older age (relative risk=2.5, P=0.0009), and previous acute graft-versus-host disease (relative risk=9.7, P=0.003).


CONCLUSIONS
In addition to previously described clinical risk factors, genetic risk factors are independently associated with the risk of developing graft-versus-host disease and may, thus, be considered for the selection of the donor.
Socié
G
G
Service d'Hématologie Greffe de Moelle, Unité Propre d'Enseignement Supérieur UPRES EA 2378 / Université Paris VII, France. gsocie@chu-stlouis.fr
Loiseau
P
P
Tamouza
R
R
Janin
A
A
Busson
M
M
Gluckman
E
E
Charron
D
D
D000293:Adolescent; D000328:Adult; D000375:Aging / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000235:genetics; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000235:genetics*; D015234:HLA-A Antigens / Q000032:analysis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011110:Polymorphism, Genetic; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
D016207:Cytokines; D015234:HLA-A Antigens