Inflammatory cytokines and acute graft-versus-host disease after reduced-intensity conditioning allogeneic stem cell transplantation

This study investigated the role of inflammatory cytokines in acute graft-versus-host disease (aGVHD) incidence and severity in 113 patients who underwent reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (alloSCT). Among all tested cytokines in the first 3 months after allo-SCT, only interleukin-12 p70 (IL-12p70) levels in the first month were significantly associated with grades II to IV aGVHD development (P <.001). IL-12p70 levels were directly correlated with aGVHD severity grade (P <.001). Before aGVHD onset, blood monocytes, the main precursor pool of IL12p70-secreting dendritic cells, recovered more rapidly in patients with grades II to IV aGVHD (P =.005). Similarly, at the effector level, there was a more robust reconstitution of naive CD3(+)CD4(+)CD45RA(+)CD27(+) T cells in patients developing grades II to IV aGVHD (P =.006). In multivariate analysis, IL-12p70 level measured in the first month was the strongest predictive factor for aGVHD development (P <.001). These findings, reconstituting a T(H)1 loop, Support a model in which aGVHD reflects a type I alloreaction after RIC allo-SCT.