Overview of GVHD Risk Factors


Catherine Lee explains risk factors that may contribute to the likelihood of a patient developing graft versus host disease.


Yi-Bin Chen, MD: Before we take patients to transplant, we have a discussion with them and their families. In our minds, as we talk about them and talk them through transplant, the risks, and the rationale, and then take them through caring for transplant afterward, all of us probably have a calculus for the risk for this patient to develop graft-vs-host disease [GVHD]. Catherine, talk a little about what you think about when you see a patient and what makes a patient more or less at risk to develop graft-vs-host disease?

Catherine J. Lee, MD, MS: When I see a patient in the clinic and I’m assessing their risk for developing graft-vs-host disease, there are definitely some factors that would trigger an alarm. Over the years, we’ve learned that some of these factors, which are listed here, absolutely contribute to graft-vs-host disease, particularly having an incompatible HLA-matched donor, an unrelated donor that isn’t a 10/10 HLA match, and the age of the recipient of the donor. An older patient and an older donor can increase the risk of graft-vs-host disease. I also become a little more aware of the potential of graft-vs-host disease when we use a female donor for a male recipient, particularly a multiparas female donor. Of course, using a G-CSF [granulocyte colony-stimulating factor]–mobilized peripheral blood graft rather than a bone marrow graft or an umbilical cord blood graft increases the risk of graft-vs-host disease.

Over time, there have been different GVHD prophylaxis platforms tested in clinical trials, and we’re learning more about GVHD prophylaxis platforms that seem to be better at preventing graft-vs-host disease. Some of the old platforms that have been used for 30 years are being usurped by newer platforms, such as post-transplant cyclophosphamide. Also, more intense conditioning, such as myeloablative regimens that use total-body radiation and high doses of radiation, is a risk factor for graft-vs-host disease. There’s a lot more research focus looking at the imbalance in the gut microbiota and the microbiome environment and how this may be contributing to graft-vs-host disease. Another risk factor that isn’t listed but that increases the risk for chronic graft-vs-host disease is having prior history of having acute graft-vs-host disease.

Yi-Bin Chen, MD: There are multiple risk factors, but sometimes we don’t have a choice. Sometimes we also have the competing interest of trying to cure malignancies. Sometimes we’ll choose the treatment based on that ultimate goal and put our patient more at risk. It’s an interesting time. It’s gratifying to see the large phase 3 clinical trials being done to prove to us in the community if there is a single answer for many of these things.

Transcript edited for clarity.

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