August 12, 2025

High donor regulatory B cells (Bregs) and their rapid recovery are associated with protection from the development of acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation.

Key Points

High donor regulatory B cell content correlates with reduced acute graft-versus-host disease risk after allo-HSCT.
Donors whose recipients developed aGVHD had significantly lower Breg percentages and absolute counts at 90 days.
Bregs recovered at slower rates in aGVHD (+) patients compared to those without aGVHD, affecting patient outcomes.
Infusion of grafts with higher median Breg content significantly decreased the risk of severe aGVHD, supporting their clinical importance.

Abstract

This study aimed to evaluate the peripheral blood donor CD19+CD24hiCD38hi regulatory B-cell (Breg) content and the Breg recovery rates during 90 days following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their correlation with the development of acute graft-versus-host disease (aGVHD). Twenty-four donor-recipient pairs with hematological malignancies who underwent unmanipulated, fully HLA-matched allo-HSCT from related siblings were enrolled. The frequency of Bregs and their absolute number were significantly lower in donors whose recipients developed aGVHD (*p = 0.005 and *p = 0.016, respectively). Acute GVHD (+) patients had a significantly diminished percentages of Bregs recovered at days 60 and 90 compared to the aGVHD (-) ones (*p 1.85% decreased the risk of grades II-IV aGVHD (hazard ratio (HR) = 0.033, 95% confidence interval CI = 0.002-0.477; *p = 0.012). Our results revealed, for the first time, that high donor Breg content and their rapid recovery within 90 days after allo-HSCT were associated with a decreased risk of aGVHD.

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