Graft-versus-host-disease in hematopoietic stem cell transplant recipients from diverse nationalities and transplant centers: a single-center cohort study in the UAE

Abstract

Abstract Background: Graft-versus-host-disease (GVHD), affecting 30-50% of cases, is a complex, multisystem disorder contributing to non-relapse mortality. In the UAE, where patients from different nationalities have historically sought transplants abroad at multiple transplant centers due to a lack of local facilities, the epidemiology of and outcomes for GVHD are unknown. Objectives: To assess the incidence, risk factors and correlations of GVHD in different organs of HSCT recipients from different transplant centers and countries. Methods: We conducted a single-center cohort study of 91 patients seen from January 2019 to December 2022. Data was extracted from Electronic Medical Records (EMRs). Descriptive statistics, bivariate correlation analyses, and relative risk calculations were utilized to present the results. Results: 32% of the recipients were from different countries of origin that underwent transplants in transplant centers globally. The male-to-female ratio among recipients was 1.27; the average recipient age was 24 years. A total of 69.2% had matched identical donors, and gender distribution among donors was 61% male and 29.6% female. The most common indications for HSCT included acute leukemia (28.4%) and Beta-thalassemia (2 0.8%). GVHD was observed in 43.9% of patients, with acute and chronic types almost equally present. Significant risk factors for GVHD included recipient age (p=0.004), HSCT indication (p=0.007), GVHD prophylaxis (p=0.03), pre-HSCT chemotherapy lines (p=0.03) and HLA match (p=0.66). The most affected organs were the skin (34%) and gastrointestinal tract (25.5%). Organ-specific GVHD correlated well with other organ GVHD, apart from lung and ocular GVHD. Risk factors aligned well with overall risk factors, except for lung GVHD. Ocular GVHD occurrence was less frequent compared to existing reports. Among the 10% deceased at study closure, 66% had GVHD. Conclusions: Predominant HSCT recipients were young and mainly had related, HLA identical donors. Our study uniquely reported that HLA matching did not significantly influence GVHD outcomes. The skin emerged as the primary site for GVHD, ocular GVHD was less common than in other studies, and lung GVHD showed no association with typical risk factors or ocular GVHD. These variations contributed to the complexity and variability of GVHD risk and manifestations, which posed challenges for post-transplant care.Sample size and heterogeneity underscore the necessity for more extensive, multi-center research.