Liver function tests and absolute lymphocyte count at day +100 are predictive factors for extensive and severe chronic graft-versus-host disease after allogeneic peripheral blood stem cell transplant

Abstract

Chronic graft-versus-host disease (cGVHD) is the major late complication after allogeneic hematopoietic stem cell transplant [1,2]. In this article, we have analyzed the value of noninvasive day 1100 tests as predictors of severe cGVHD development in 165 patients undergoing allogeneic peripheral blood stem cell transplant (allo-PBSCT) from a matched related donor. The cumulative incidence of overall, extensive, and severe cGVHD was 67, 56, and 23%, respectively, among patients surviving >100 days after transplant. In univariate analysis, patients displaying an abnormal liver function tests (LFTs) (total bilirubin, alkaline phosphatase, and GGT > 2 times above the upper normal limit) and a low absolute lymphocyte count (ALC) (<percentile 25: 0.750 x 109/L) had a significantly higher risk of overall, extensive, and severe cGVHD. In multivariate analysis, the combination of abnormal LFT and low ALC allowed to predict the risk of overall [HR = 3.35 (95% Cl: 1.65-6.83), P < 0.001], extensive [HR = 4.22 (95% Cl: 1.96-9.12), P < 0.001], and severe cGVHD [HR = 8.17 (95% CI: 2.55-26.17), P = 0.002]. Our findings show that an increased total bilirubin, alkaline phosphatase, and GGT levels together with the ALC at day +100 are noninvasive, simple, fast, and efficient predictors of severe cGVHD development after allogeneic PBSCT.