CD19+CD21low B Cells and CD4+CD45RA+CD31+ T Cells Correlate with First Diagnosis of Chronic Graft-versus-Host Disease

•Cellular subsets in peripheral blood were assessed prospectively in patients with and without chronic graft-versus-host disease.•Increased B and T cell subsets on day 100 after hematopoietic stem cell transplantation were significantly associated with later development of chronic graft-versus-host disease.•Increased B and T cell subsets characterized new onset chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is a serious and frequent complication of allogeneic hematopoietic stem cell transplantation (HCT). Currently, no biomarkers for prediction and diagnosis of cGVHD are available. We performed a large prospective study focusing on noninvasive biomarkers for National Institutes of Health–defined cGVHD patients (n = 163) in comparison to time-matched HCT recipients who never experienced cGVHD (n = 64), analyzed from day 100 after HCT. In logistic regression analysis, CD19+CD21low B cells (P = .002; hazard ratio [HR], 3.31; 95% confidence interval [CI], 1.53 to 7.17) and CD4+CD45RA+CD31+ T cells (P < .001; HR, 3.88; 95% CI, 1.88 to 7.99) assessed on day 100 after HCT were significantly associated with subsequent development of cGVHD, independent of clinical parameters. A significant association with diagnosis of cGVHD was only observed for CD19+CD21low B cells (P = .008; HR, 3.00; 95% CI, 1.33 to 6.75) and CD4+CD45RA+CD31+ T cells (P = .017; HR, 2.80; 95% CI, 1.19 to 6.55). CD19+CD21low B cells were found to have the highest discriminatory value with an area under the receiver operating curve of .77 (95% CI, .64 to .90). Our results demonstrate that CD19+CD21low B cells and CD4+CD45RA+CD31+ T cells are significantly elevated in patients with newly diagnosed cGVHD.