Acute GVHD after allogeneic hematopoietic transplantation affects early marrow reconstitution and speed of engraftment

Our aim was to study the influence of acute graft-versus-host disease (a-GVHD) on primary engraftment times after allogeneic transplantation. Primary engraftment and frequency of marrow granulocyte-macrophage colony-forming units and erythroid burst-forming units, at day +18, were studied in 126 allogeneic transplants. Patients were grouped according to the time when a-GVHD treatment with corticosteroids was started. The no-a-GVHD group are those who, during the first 3months, had no need for a-GVHD treatment; the early-a-GVHD group are those who needed a-GVHD treatment within 19days; and the postengraftment-a-GVHD group are those who were not on corticosteroid treatment at the time of engraftment but needed it after day +19. The no-a-GVHD group reached a neutrophil count (N)>0.5×10⁹/L in a median of 17.8days. The postengraftment-a-GVHD group reached N>0.5×10⁹/L in a median of21.4days (p=0.0003). The early-a-GVHD group had N>0.5×10⁹/L in a median of +17.0days (p=0.23). When factors important for engraftment were studied in a multivariate analysis, postengraftment a-GVHD was a significant factor in delayed neutrophil and platelet engraftment. Both the early-a-GVHD and postengraftment-a-GVHD groups showed a significant reduction in frequency of granulocyte-macrophage colony-forming units and erythroid burst-forming units found in marrow at day +18. In conclusion, a-GVHD may influence early marrowreconstitution and is a relevant factor for primary myeloid and platelet engraftment.