Prognostic factors of acute and chronic graft-versus-host disease in pediatric patients undergoing bone marrow haploidentical transplant with post-transplantation cyclophosphamide
Abstract
Objective Haploidentical hematopoietic stem cell transplantation has become an important therapeutic option for pediatric patients lacking an HLA-identical donor. This study aimed to identify clinical and transplant-related predictors of graft-versus-host disease in Tunisian children undergoing haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide. Methods A retrospective study, conducted at the National Blood Transfusion Center, in collaboration with the National Bone Marrow Transplantation Center, included 47 pediatric patients transplanted between January 2019 and December 2023. Associations with acute and chronic graft-versus-host disease were assessed using contingency tables with odds ratios and 95% confidence intervals, followed by multivariate logistic regression for relevant variables. Results Forty-eight transplant procedures were analyzed. In the univariate analysis, most parameters, including graft cellular content, conditioning regimen, donor age, underlying disease, donor-specific antibodies and ABO incompatibility, were not associated with graft-versus-host disease. In contrast, donor–recipient sex mismatch significantly increased the risk of acute graft-versus-host disease (OR = 10.0; 95% CI: 2.26–44.20; p = 0.0024) and was confirmed as an independent predictor on multivariate analysis (OR = 17.7; 95% CI: 0.13–297.9; p = 0.0068). No variable emerged as a significant determinant of chronic graft-versus-host disease. Conclusions In this cohort, donor–recipient sex mismatch was the main risk factor for acute graft-versus-host disease, while no clear predictor was identified for chronic disease. Larger prospective studies are needed to validate these findings and to refine predictive models, with the ultimate aim of optimizing haploidentical hematopoietic stem cell transplantation protocols and improving outcomes.