Lower levels of vitamin A are associated with increased gastrointestinal graft-versus-host disease in children

Dana T. Lounder, Pooja Khandelwal, Christopher E. Dandoy, Sonata Jodele, Michael S. Grimley, Gregory Wallace, Adam Lane, Cynthia Taggart, Ashley C. Teusink-Cross, Kelly E. Lake and Stella M. Davies

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  • RE: Vitamin A Levels and Acute GI GVHD in Adults Following Allogeneic Hematopoietic Stem Cell Transplantation
    • Yvonne A. Efebera, Physician The Ohio State University
    • Other Contributors:
      • Parvathi Raganathan, Researcher
      • Dana T. Lounder, Physician
      • Adam Lane, Physician
      • Pooja Khandelwal, Physician
      • Stella M Davies, Physician
      • Samantha Jaglowski, Physician
      • Sumithira Vasu, Physician
      • Ramiro Garzon, Physician
      • Steven M Devine, Physician


    Acute graft-versus-host-disease (aGVHD) is the major complication of allogeneic hematopoietic stem cell transplantation (alloHSCT)1-3.  Our collaborators at Cincinnati Children’s Hospital Medical Center (CCHMC) recently identified low levels of Vitamin A as a risk factor for increased GI aGVHD in pediatric patients undergoing alloHSCT4.  We present data from the adult population.  Previously banked plasma collected from 100 adult recipients at day 30 post alloHSCT on an Institutional Review Board approved protocol were assayed for free vitamin A levels as previously described4.The median age was 50.5 years. Donor source was 56% related and 35% unrelated, with 83% having a 10/10 HLA-matched donor and 78% receiving peripheral blood stem cells. All patients received standard calcineurin inhibitor based aGVHD prophylaxis. The overall incidence of grade 2-4 aGVHD was 39% with grade 3-4 aGVHD at 12% by consensus criteria5.  The cumulative incidence of GI GVHD was significantly increased in patients with low vitamin A levels (42.7% below median vs 22.9% above median at 1 year; p=0.02, Fig 1a) Overall GVHD was also increased, though not significantly (60.3% below median vs 45.6% above median at 1 year; p=0.063, Fig 1b). There was no difference in OS by median vitamin A levels (p=0.83, Fig 1c).

    We confirm in adult alloHSCT patients the association between day +30 vitamin A levels and GI aGV...

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    Conflict of Interest:
    None declared.