Decline of serum albumin precedes severe acute GvHD after haploidentical HSCT.

BACKGROUND Haploidentical hematopoietic stem cell transplantation (HSCT) is a useful therapy for relapsed/refractory acute leukemia or lymphoma because of the strong graft-versus-leukemia (GvL) effect. However, it is often accompanied by severe acute graft-versus-host disease (GvHD), which is the most serious complication after haploidentical HSCT. Thus, it is important to control the severity of acute GvHD while maintaining the GvL effect. In our experiences of pediatric haploidentical HSCT, it takes several days for acute GvHD to become severe after the appearance of initial symptoms, mostly skin rashes. In this study, we aimed to identify useful biomarkers at the onset of acute GvHD that predict subsequent development of severe acute GvHD. METHODS Forty-five consecutive children with relapsed/refractory acute leukemia or lymphoma who developed acute GvHD after haploidentical HSCT were enrolled. We analyzed possible biomarkers from samples collected at the onset of acute GvHD. RESULTS Nineteen patients developed grade 1-2 acute GvHD, and 26 patients developed grade 3-4 acute GvHD. There was no significant difference in patient characteristics between the two groups. Transplant-related mortality occurred only in the grade 3-4 acute GvHD group (34.5%). Multivariate analysis revealed that serum albumin was an independent biomarker for predicting the severity of acute GvHD (p=0.009). The area under the receiver operating characteristic curve of serum albumin was 0.864. CONCLUSIONS The serum albumin level at the onset of acute GvHD could be a useful biomarker for the development of subsequent severe acute GvHD in pediatric patients after haploidentical HSCT.