Graft-Versus-Host Disease (GVHD) in the United Arab Emirates (UAE): Risk Factors, Organ-Specific Correlations, and Transplant Outcomes

Background GVHD, affecting 30-50% of cases, is a complex, multisystem disorder contributing to non-relapse mortality. This study gains importance as it is the first in the UAE, where most patients have historically sought transplants abroad due to a lack of local facilities. Objectives To profile hematopoietic stem cell transplant (HCT) recipients in the UAE, assess the incidence and distribution of GVHD, identify associated risk factors, and examine organ-specific correlations. Material and Methods We conducted a single-center cohort study involving 91 patients seen from 2019 to 2022, using data extracted from Electronic Medical Records. Descriptive statistics, bivariate correlation analyses, and relative risk (RR) calculations were used. Results The male-to-female ratio among recipients was 1.27; the median age was 24 years. A total of 69.2% had HLA identical donors, and 61.5% donors were male. Common indications for HCT included acute leukemia (28.4%), Beta-thalassemia (20.8%) and Severe combined immunodeficiency (12%). Recipient age (p=0.004), donor relation to recipient (p=0.04), HCT indication (p=0.007), no. of lines of treatment before HCT (p=0.03), and GVHD prophylaxis (p=0.03) were significantly associated with GVHD (Table 1).GVHD was observed in 43.9% of patients, with acute and chronic types being equally prevalent. For prophylaxis, cyclosporin (34%), and calcineurin inhibitors (23%) containing regimens were used. Risk factors associated with higher GVHD incidence included recipient age over 50 years (RR=2.17, CI,1.4-3.2) and malignant diseases (RR=2.12, CI,1.2-3.5). Lower risk was observed with related donors (RR=0.65, CI,0.39-1), recipient age under 20 years (RR=0.43, CI,0.26-0.7), number of lines of treatment less than or equal to 1 (RR=0.67, CI,0.42-1), and regimens containing calcineurin inhibitors (RR=0.7, CI,0.4-1.2) (Figure 1).The most affected organs were the skin (34%), GI tract (25.5%) and ocular (16.8%). Organ-specific GVHD correlations aligned with overall risk factors, except for lung GVHD. Ocular GVHD was less prevalent in our cohort at 16%. GVHD in various organs correlated with each other (p<0.05), except for correlation between lung and eye GVHD (p=0.45). Among the 10% deceased at study closure, 66% had GVHD (Table 2). Conclusions In UAE, the predominant HCT recipients were young and had identical HLA donors. While the incidence and conventional risk factors for GVHD mirrored existing literature, our study uniquely reported that HLA matching did not influence GVHD outcomes. The skin emerged as the primary site for GVHD, ocular GVHD was less common than in other studies, and lung GVHD showed no association with typical risk factors or ocular GVHD. The limitations of our study, such as a small sample size and sample heterogeneity, underscore the necessity for more extensive, multi-center research in UAE for validation.