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Background <p>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is curative for hematologic malignancies, yet diarrhea after allo-HSCT—mainly due to gastrointestinal graft-versus-host disease (GI-GVHD) or viral infection—remains a major clinical challenge. Early etiological differentiation is essential for appropriate management.</p> Aims <p>This study aimed to develop an immune-based predictive model by dynamically monitoring lymphocyte subsets and cytokines after allo-HSCT.</p> Results <p>Among 232 patients who underwent allo-HSCT at Beijing Lu Daopei Hospital between 2021 and 2024, 58 developed biopsy-confirmed post-transplant (post-HSCT) diarrhea, comprising 34 cases of GI-GVHD and 24 cases of viral enteritis. Immune profiles were measured one week prior to diarrhea onset, as well as at weeks 4 and 5 post-HSCT. Predictive features were selected using LASSO and logistic regression to construct single- and multi–time–point models, which were validated using nomogram, calibration, and decision curve analyses. At the pre-diarrhea point, patients with aGVHD had higher Reg3α, CD3⁺T%, CD8⁺T%, naive CD4⁺/CD4⁺T%, and Th2/CD4⁺T%, but lower NK count and NK% (all <i>P</i> &lt; 0.05). The single-time-point model achieved good discrimination (AUC = 0.799), while the multi–time-point model integrating nine dynamic parameters showed superior accuracy (AUC = 0.908). Conclusions: Dynamic immune profiling may aid in the early distinction between GI-GVHD and viral enteritis, highlighting its potential as a tool for immunological surveillance to guide intervention after allo-HSCT.</p>

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Dynamic immune profiling enables early distinction between gastrointestinal GVHD and viral diarrhea after hematopoietic stem cell transplantation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月25日

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  • Man Chen,
  • Xue-qiao Wang,
  • Jing Long,
  • Min-Jing Fu,
  • Hui Wang,
  • Wei Zhao

摘要

Background

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is curative for hematologic malignancies, yet diarrhea after allo-HSCT—mainly due to gastrointestinal graft-versus-host disease (GI-GVHD) or viral infection—remains a major clinical challenge. Early etiological differentiation is essential for appropriate management.

Aims

This study aimed to develop an immune-based predictive model by dynamically monitoring lymphocyte subsets and cytokines after allo-HSCT.

Results

Among 232 patients who underwent allo-HSCT at Beijing Lu Daopei Hospital between 2021 and 2024, 58 developed biopsy-confirmed post-transplant (post-HSCT) diarrhea, comprising 34 cases of GI-GVHD and 24 cases of viral enteritis. Immune profiles were measured one week prior to diarrhea onset, as well as at weeks 4 and 5 post-HSCT. Predictive features were selected using LASSO and logistic regression to construct single- and multi–time–point models, which were validated using nomogram, calibration, and decision curve analyses. At the pre-diarrhea point, patients with aGVHD had higher Reg3α, CD3⁺T%, CD8⁺T%, naive CD4⁺/CD4⁺T%, and Th2/CD4⁺T%, but lower NK count and NK% (all P < 0.05). The single-time-point model achieved good discrimination (AUC = 0.799), while the multi–time-point model integrating nine dynamic parameters showed superior accuracy (AUC = 0.908). Conclusions: Dynamic immune profiling may aid in the early distinction between GI-GVHD and viral enteritis, highlighting its potential as a tool for immunological surveillance to guide intervention after allo-HSCT.