Dynamics of monocytic myeloid-derived suppressor cell recovery and interleukin-10 production on graft-versus-host disease and cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation.
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BACKGROUND: Myeloid-derived suppressor cells (MDSCs) suppress immune responses. We hypothesized that MDSCs and their related cytokines/chemokines after receiving allogeneic hematopoietic cell transplantation (allo-HCT) impact graft-versus-host disease (GVHD) and infectious complications. METHODS: This study investigated the dynamics of MDSCs recovery using flow cytometry. Cytokines/chemokines were measured by the Luminex assay and correlated with clinical outcomes. RESULTS: Forty-nine patients who underwent allo-HCT at King Chulalongkorn Memorial Hospital from 2022 to 2023 were enrolled. The median age was 42 years. Most cases (81.6 %) were acute leukemia. Peripheral blood stem cells were collected from human leukocyte antigen-matched related/unrelated donors (85.7 %) or haploidentical donors (14.3 %). Forty-six patients (93.9 %) received myeloablative conditioning regimens. GVHD prophylaxis regimens were calcineurin inhibitor plus methotrexate (67.3 %) and post-transplantation cyclophosphamide (32.7 %). Acute GVHD occurred in 9 (18.4 %) patients with a median onset of 35 days. The percentage of monocytic MDSC (M-MDSC), interleukin-10 (IL-10) and CXCL2 levels on day+28 of acute GVHD patients were all significantly lower than non-GVHD patients (0.26 % vs. 0.55 %, p = 0.048, 15.45 pg/ml vs. 23.53 pg/ml, p = 0.041, and 201.44 pg/ml vs. 428.42 pg/ml, p = 0.029, respectively). Cytomegalovirus (CMV) reactivation was detected in 69.4 % of patients with a median onset of 39 days. CMV reactivation was related to higher M-MDSC percentage on day+14 and IL-10 on day+28 compared with no reactivation (0.76 % vs. 0.22 %, p = 0.047 and 24.35 pg/ml vs. 16.42 pg/ml, p = 0.003, respectively). CONCLUSION: Delayed M-MDSC reconstitution and low IL-10 were associated with acute GVHD, while high numbers of M-MDSCs and higher IL-10 levels increased the risk of CMV reactivation.