Interleukin-6 as Biomarker for Acute GvHD and Survival After Allogeneic Transplant With Post-transplant Cyclophosphamide

Raffaella Greco, Francesca Lorentino, Rosamaria Nitti, Maria Teresa Lupo Stanghellini, Fabio Giglio, Daniela Clerici, Elisabetta Xue, Lorenzo Lazzari, Simona Piemontese, Sara Mastaglio, Andrea Assanelli, Sarah Marktel, Consuelo Corti, Massimo Bernardi, Fabio Ciceri, Jacopo Peccatori

Research output: Contribution to journalArticlepeer-review


Background: Although the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) has dramatically improved in the past decade, it is still compromised by transplant-related mortality (TRM), mainly caused by Graft-vs. -Host Disease (GvHD). Methods: We conducted a prospective observational study to ascertain the potential of serum interleukin-6 (IL6) levels, measured before conditioning and 7 days after allo-HSCT, in predicting acute GvHD, TRM and survival after allo-HSCT with Post-Transplant Cyclophosphamide (PT-Cy) based GvHD prophylaxis. Results: Between April 2014 and June 2017, we collected samples from 166 consecutive allo-HSCT patients. By ROC analysis, we identified a threshold of 2.5 pg/ml for pre-transplant IL6 and 16.5 pg/ml for post-transplant IL6. Both univariate and multivariate analyses confirmed the ability of high baseline IL6 levels to predict worse OS (HR 4.3; p < 0.01) and grade II–IV acute GvHD (HR 1.8; p = 0.04), and of high post-transplant IL6 to identify patients with worse OS (HR 3.3; p < 0.01) and higher risk of grade II–IV (HR 5; p < 0.01) and grade III–IV acute GvHD (HR 10.2; p < 0.01). In multivariate analysis, both baseline (HR 6.7; p < 0.01) and post-transplant high IL6 levels (HR 3.5; p = 0.02) predicted higher TRM. Conclusions: IL6 may contribute to the risk stratification of patients at major risk for aGvHD and TRM, potentially providing a window for additional prophylactic or preemptive strategies to improve the quality of life in the early post-transplant phase and the outcome of allo-HSCT.

Original languageEnglish
Article number2319
JournalFrontiers in Immunology
Publication statusPublished - Oct 1 2019


  • allogeneic hematopoietic stem cell transplantation
  • graft-vs.-host disease
  • interleukin-6
  • overall survival
  • transplant-related mortality

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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