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 hematopoi etic stem cell transplantation. Recently, pro- and anti-inflammatory cytoki nes and mismatches of minor histocompatibility antigens between HLA-identic al sibling donor/recipient pairs have been implicated in the development of acute graft-versus-host disease. It is not known, however, whether these f actors 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-id entical sibling donor. Eight polymorphisms from five different cytokine gen es were studied (tumor necrosis factor alpha, tumor necrosis factor beta, i nterleukin (IL) 6, IL-10, and interferon gamma). Mismatches for the minor h istocompatibility 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 proporti onal 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 <0.0 001) 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 (relati ve risk=2.8, P=0.05). Chronic graft-versus-host disease was independently a ssociated 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 graf t-versus-host disease (relative risk=9.7, P=0.003). Conclusion. In addition to previously described clinical risk factors, gene tic risk factors are independently associated with the risk of developing g raft-versus-host disease and may, thus, be considered for the selection of the donor.