Analysis Of Risk Factors Of Acute Graft-Versus-Host Disease After Haploid Hematopoietic Stem Cell Transplantation

Objective: To investigate the risk factors of acute graft-versus-host disease(aGVHD)after haploid hematopoietic stem cell transplantation(haplo-HSCT),and to provide more evidence for the early prediction of aGVHD.Methods: A retrospective analysis was performed on 45 patients who received haplo-HSCT in the hematology Department of the 940 th Hospital of the Joint Logistics Support Force from January 2019 to December 2022.Among them,26 patients developed aGVHD and 19 patients without aGVHD.For patients who meet the inclusion criteria,collect the patient’s age,gender,type of primary disease,donor gender,donor/recipient human leukocyte antigen(HLA)typing,donor/recipient ABO blood type,pretreatment protocol,transplantation type,mononuclear cell(MNC)count in the graft,CD34+ cell count,hematopoietic stem cell source,neutrophils(ANC)and platelet implantation status,aGVHD prevention protocol,time of occurrence of aGVHD Basic information such as severity and treatment plan.SPSS26.0 software was used to compare between groups,and the effects of cytokines IL-6,IL-8 and lymphocyte subsets(T lymphocyte subsets,CD19+B lymphocytes and NK cells)on aGVHD occurrence in serum of patients at +28 days,+56 days and +90 days were analyzed.The effects of serum β2-microglobulin(β2-MG)concentration,lactate dehydrogenase(LDH)level,albumin and whether infection before transplantation on aGVHD in patients receiving haplo-HSCT were analyzed.Results: Among the 45 patients,26 had aGVHD,with an incidence of 57%.A total of34 cases of aGVHD occurred,including skin type 21(61%),gastrointestinal type 11(32%),and liver type 2(5.8%).There were no statistically significant differences in patients’ gender,age,ABO blood group relationship between donors and recipients,gender differences between donors and recipients,and whether infection was present before transplantation(P＞0.05);Among them,the incidence of aGVHD in patients with aplastic anemia(AA)was75%(6/8),the incidence of aGVHD in patients with myelodysplastic syndrome(MDS)was66.7%(2/3),the incidence of aGVHD in patients with acute lymphocytic leukemia(ALL)was 47.1%(8/17),and the incidence of aGVHD in patients with acute myeloid leukemia(AML)was 58.8%(10/17),with no statistically significant difference(P＞0.05);Blood biochemical indicators before transplantation(There was no significant difference in β2-MG,LDH,albumin),ANC implantation time,MNC count,and CD34+cell count(P＞0.05).The level of IL-6 in the aGVHD group on+90 days after transplantation was higher than that in the non aGVHD group,with a statistically significant difference(P=0.024).The level of IL-8 in the aGVHD group on +56 days after transplantation was higher than that in the non aGVHD group,with a statistically significant difference(P=0.035).There was a statistically significant difference between the two groups on+90 days after transplantation in the percentage of CD4+T lymphocytes,+28 days in the percentage of CD4-CD8-T lymphocytes,and+28 days in the percentage of CD19+ B lymphocytes(P＜0.05).Conclusion:1.The occurrence of aGVHD is most common in skin type,followed by gastrointestinal type and liver type.2.The occurrence of aGVHD after haploid hematopoietic stem cell transplantation was not related to serum β2-MG,LDH,albumin level,and co-infection.3.Abnormal changes in cytokines(IL-6,IL-8)and lymphocyte subsets(T-lymphocyte subsets,CD19+ B lymphocytes)after haploid hematopoietic stem cell transplantation are associated with the occurrence of aGVHD.Dynamic monitoring of changes in cytokines(IL-6,IL-8),T-lymphocyte subsets,and CD19+ B lymphocytes after transplantation can help predict the occurrence of aGVHD.