From the Guidelines
There is a potential association between Graft-Versus-Host Disease (GVHD) and poor graft function, as suggested by a systematic review and meta-analysis published in 2023 1. This association is based on the findings of several studies that investigated potential risk factors for poor graft function after hematopoietic cell transplantation.
- The study found that a history of GVHD was correlated with poor graft function in 5 out of 13 studies, with a predictive percentage of 38% 1.
- Other potential risk factors for poor graft function included a history of cytomegalovirus (CMV) infection, splenomegaly, donor-recipient relatedness, major blood group mismatch, high recipient age, high serum ferritin, and history of other viral reactivation 1.
- However, it is essential to note that the association between GVHD and poor graft function is not fully understood and may be influenced by various factors, including the type of transplantation, conditioning regimens, and immunosuppression protocols.
- A previous study published in 2000 highlighted the importance of GVHD as a substantial risk factor for infection among hematopoietic stem cell transplant recipients, particularly those receiving matched, unrelated donor transplants 1.
- The exact mechanisms underlying the potential association between GVHD and poor graft function require further investigation, but it is clear that GVHD can have a significant impact on the outcomes of hematopoietic cell transplantation.
- In clinical practice, it is crucial to carefully monitor patients for signs of GVHD and poor graft function, and to adjust treatment strategies accordingly to minimize the risk of these complications and optimize patient outcomes.
From the Research
Association between Graft-Versus-Host Disease (GVHD) and Delayed Graft Function
- There is evidence to suggest an association between GVHD and delayed graft function, particularly in the context of hematopoietic stem cell transplantation (HSCT) 2, 3.
- A study published in 2018 found that delayed platelet recovery after allogeneic HSCT was associated with a low incidence of chronic GVHD, despite a comparable relapse rate 2.
- Another study published in 2021 discussed the concept of hematopoietic dysfunction during GVHD, which may contribute to delayed graft function and high mortality rates after HSCT 3.
- The exact mechanisms underlying this association are not fully understood, but it is thought that excessive immune activation during GVHD may damage hematopoietic stem and progenitor cells, leading to reduced cell number and functionality 3.
- Other factors, such as immune suppressive therapy, infections, and changes in the microbiome, may also contribute to hematopoietic dysfunction and delayed graft function in patients with GVHD 3.
Key Findings
- Delayed platelet recovery after allogeneic HSCT is associated with a low incidence of chronic GVHD 2.
- GVHD is associated with severe and long-lasting hematopoietic dysfunction, which may contribute to delayed graft function and high mortality rates after HSCT 3.
- Excessive immune activation during GVHD may damage hematopoietic stem and progenitor cells, leading to reduced cell number and functionality 3.
- Immune suppressive therapy, infections, and changes in the microbiome may also contribute to hematopoietic dysfunction and delayed graft function in patients with GVHD 3.
Studies on GVHD and HSCT
- A study published in 2020 compared the effects of tacrolimus and cyclosporine combined with methotrexate for GVHD prophylaxis after allogeneic HSCT, and found that tacrolimus was associated with a significant reduction in the rate of grade II to IV acute GVHD 4.
- A study published in 2003 compared the incidence and severity of GVHD after nonmyeloablative versus conventional HSCT, and found that nonmyeloablative HSCT was associated with a lower cumulative incidence of grades II-IV acute GVHD 5.
- A study published in 2002 discussed the late effects of HSCT, including chronic GVHD and delayed recovery of the immune system 6.