ArticleBMC immunology2026
Infused PMN-MDSCs from G-CSF-mobilized PBSCs protect against II-IV° acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.
Article in BMC immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMyeloid-derived suppressor cells (MDSCs) are potent immunoregulatory cells. Their role in modulating acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. This study aimed to investigate the impact of MDSC levels in granulocyte colony-stimulating factor (G-CSF)–mobilized peripheral blood stem cell (PBSC) grafts on the incidence of II–IV° aGVHD.
resultsWe retrospectively analyzed 170 allo-HSCT recipients. Employing an exposure-based analytical framework, patients were stratified into high- and low-dose groups based on the infused dose of polymorphonuclear MDSCs (PMN-MDSCs). In Fine-Gray competing risk analyses, a high dose of PMN-MDSCs per kilogram (> 17.5 × 10⁶/kg) was an independent protective factor against aGVHD (subdistribution hazard ratio [sHR] 0.25, 95% CI 0.07–0.88, P = 0.039). A clinically applicable optimal cut-off was identified at 11.3 × 10⁶/kg. Patients receiving a PMN-MDSC dose > 11.3 × 10⁶/kg had significantly superior 300-day overall survival (92.4% vs. 74.9%, P = 0.005) and GVHD-free relapse-free survival (76.3% vs. 40.4%, P < 0.001) compared to the low-dose group. In the malignant disease subset (n = 147), a high dose of the activated LOX-1⁺ PMN-MDSC subset was associated with a markedly lower cumulative incidence of relapse (1.37% vs. 11.42%, P = 0.015). Longitudinal monitoring revealed that the peak incidence of aGVHD (median day + 29) closely followed the peak and subsequent decline of circulating MDSC levels.
conclusionsThe absolute dose of PMN-MDSCs in G-CSF-mobilized grafts is an independent determinant of II–IV°aGVHD risk and survival outcomes, with a defined threshold of 11.3 × 10⁶/kg. These findings position PMN-MDSC dose as a promising biomarker for risk stratification and a potential lever for optimizing graft composition in allo-HSCT.
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