A stem cell transplant can allow your acute myeloid leukemia (AML) care team to administer higher doses of chemotherapy, increasing the likelihood that AML treatment will be successful. An allogeneic stem cell transplant, using blood-forming stem cells from a donor, is the most common type used to treat AML. This type of transplant relies on the donor cells to recognize the leukemia cells and to kill them.

While a stem cell transplant from a donor reduces the risk of relapse with AML, it comes with the risk of a complication called graft-versus-host disease (GVHD). GVHD develops when immune cells from the donor, delivered via stem cell transplant, attack your tissues and organs.

Some studies suggest that a little more than half of people who get donor stem cell transplants for acute leukemia develop GVHD. In this article, we’ll discuss what the research says about the risk of GVHD after a stem cell transplant for AML. We’ll also cover GVHD risk factors.

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Likelihood of Developing GVHD After a Stem Cell Transplant for AML

Multiple studies have evaluated the risk of GVHD in people who’ve had donor stem cell transplants for blood cancers. Between 45 percent and 50 percent of all allogeneic stem cell transplants are performed on people with AML.

One study that compared rates of GVHD after donor stem cell transplants found that GVHD was most likely to develop in people with acute or chronic myeloid leukemia compared to other blood disorders.

In this study, about 34 percent of people who received allogeneic stem cell transplants for blood disorders developed GVHD, including 7 of the 10 participants with AML.

Acute GVHD Risk

There are two main types of GVHD: acute GVHD and chronic GVHD.

Acute GVHD can start within days of the stem cell transplant or appear up to six months later. GVHD can affect many different parts of the body, but acute GVHD mostly causes symptoms involving the liver, skin, and gastrointestinal (GI) tract.

Some research looked at people who received allogeneic stem cell transplants from mismatched donors, or donors with tissue types that didn’t align completely with the recipients’ tissue types. In this group, which included many people with AML, 46 percent of stem cell transplant recipients developed acute GVHD.

Research suggests that the incidence of severe acute GVHD after a stem cell transplant for AML is decreasing over time.

Chronic GVHD Risk

Chronic GVHD is graft-versus-host disease that develops more than three months after a stem cell transplant. It can appear at any point in your life after a stem cell transplant (even years later).

In a study that evaluated people who received allogeneic stem cell transplants from mismatched donors, including many people with AML, 18 percent of stem cell transplant recipients developed chronic GVHD. Other research suggests that rates of chronic GVHD after a stem cell transplant for AML have been declining in recent years.

Risk Factors for Developing GVHD

Not everyone who receives a stem cell transplant for AML has the same risk of developing GVHD. Several risk factors can increase your likelihood of developing acute or chronic GVHD after a bone marrow transplant for AML.

Mismatched or Unrelated Donor

When you receive an allogeneic stem cell transplant for AML, your care team tries to find a donor who is as closely matched to you as possible. To do this, they look at protein markers on your cells called human leukocyte antigens (HLA).

It isn’t always possible to find a closely matching donor. Highly mismatched HLA types can increase the risk of moderate to severe acute GVHD.

Donor Age

The age of your stem cell donor can also affect your GVHD risk. Stem cell transplant recipients with younger donors are less likely to develop GVHD than recipients with donors of an older age. Stem cells from donors aged 37 or older may carry a higher risk of GVHD for the recipient.

A small study found that a stem cell transplant from an older donor may be less likely to result in AML relapse. However, more research is needed to confirm this, and the evidence on older donor age increasing the risk for GVHD is more established.

Donor and Recipient Gender

The pairing of the donor’s and recipient’s genders may also affect your likelihood of developing GVHD after a stem cell transplant for AML. According to a study in the medical journal Blood Advances, the risk of GVHD may be increased for male recipients with female donors.

Researchers aren’t quite sure why female donor stem cells increase the risk of GVHD for male recipients. One possible explanation is that stem cells from female donors react to male-specific antigens in a specific way, leaving the door open to complications like GVHD. If you’re a male stem cell recipient, your care team may prioritize finding a male donor.

Stem Cell Source

Blood-forming stem cells for a stem cell transplant can come from the donor’s blood or from their bone marrow, which is why a stem cell transplant is also called a bone marrow transplant. Although both sources are used, the source of the stem cells you receive has some influence over your GVHD risk.

Peripheral blood is more commonly used for stem cell transplants for cancer treatment than bone marrow. However, stem cell transplants that use blood instead of bone marrow have a higher risk of causing severe acute GVHD. Stem cells from blood are also more likely to lead to chronic GVHD in people with AML.

Although the stem cell source can affect your GVHD risk, it doesn’t appear to affect the risk of an AML relapse. There’s also no risk difference between blood stem cells and bone marrow stem cells for nonrelapse complications.

Prior Acute GVHD

Having acute GVHD may increase your risk of developing chronic GVHD later on. Yet, in a study that looked at stem cell transplant outcomes of only people with acute leukemias, researchers weren’t able to confirm this risk factor.

The difference in findings could be because most participants in the study received a reduced-intensity transplantation, which doesn’t appear to come with an increased risk for chronic GVHD after a prior acute GVHD. Reduced-intensity conditioning before a stem cell transplant involves lower doses of chemotherapy or radiation before the transplant with a goal of lowering your risk for complications. This type of reduced conditioning relies more on the donor cells’ ability to kill leukemia cells rather than high doses of chemotherapy.

Talk to Your AML Specialist

If your blood cancer specialist has recommended a stem cell transplant, talk to them about your GVHD risk. They can help you understand your individual risk for GVHD and other potential treatment complications based on your medical history, donor, and other factors. They can discuss ways to lower your risk of acute or chronic GVHD.

If you’ve had a donor stem cell transplant for AML, it’s important to notify your healthcare team right away if you experience potential GVHD symptoms. Be sure to mention any new or worsening diarrhea, nausea, itching, muscle aches, or jaundice, even if these or other symptoms appear months or years after your stem cell transplant.

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