Low dose of sitagliptin: effectively prevent liver aGVHD and accelerate neutrophil engraftment.
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After allogeneic hematopoietic stem cell transplantation (allo-HSCT), the incidence of moderate-to-severe acute graft-versus-host disease (aGVHD) is approximately 13% to 47%. Currently, the standard regimen for the prevention of aGVHD is a calcineurin inhibitor (CNI) plus short-course methotrexate (MTX), with the addition of mycophenolate mofetil (MMF), anti-human thymocyte globulin (ATG), or anti-CD25 monoclonal antibody depending on the type of donor. This study aims to evaluate whether the addition of sitagliptin to standard aGVHD prophylaxis can further reduce the incidence and severity of aGVHD, while enhancing stem cell engraftment and improving the overall prognosis of patients undergoing allo-HSCT. The clinical data of 66 patients with malignant hematopoietic diseases who underwent allogeneic hematopoietic stem cell transplantation for the first time at the Department of Hematology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between 1 January 2022 and 1 January 2024 were retrospectively collected. According to the aGVHD prophylaxis regimen received, the patients were divided into the Sitagliptin group (n = 33) and the Standard group (n = 33). Statistical methods were used to compare the clinical outcomes between the two groups, including hematopoietic engraftment, acute GVHD, chronic GVHD, and overall survival (OS) after allogeneic hematopoietic stem cell transplantation. By day + 100 after transplantation, all patients in both groups had achieved engraftment. The Sitagliptin group had faster neutrophil engraftment than the Standard group (median 9 days, 95% CI 8.55–9.45 vs. median 11 days, 95% CI 10.39–11.61; p < 0.001). The cumulative incidence of grade II–IV aGVHD by day + 100 was 39.4% (95% CI 17%–35%) in the Standard group compared with 30.3% in the Sitagliptin group (p = 0.26). Corresponding values for grade III–IV aGVHD were 12.1% (95% CI 3.7%–25.8%) in the Standard group versus 9.1% (95% CI 2.3%–21.9%) in the Sitagliptin group (p = 0.70). For organ-specific aGVHD, the incidence of liver aGVHD was significantly lower in the Sitagliptin group (3.1%, 95% CI 0.2%–14%) than in the Standard group (18.2%, 95% CI 7.2%–33.1%; p = 0.044).