Vitamin E and acute graft‐versus‐host disease after myeloablative allogeneic hematopoietic cell transplantation

Objectives Vitamin E has antioxidant and immunomodulatory effects that might influence the development of acute graft‐versus‐host disease (GvHD). We investigated the association between plasma vitamin E levels and acute GvHD. Methods We studied 115 adults who underwent myeloablative allogeneic hematopoietic cell transplantation between July 2015 and August 2018. Vitamin E was measured by high‐performance liquid chromatography in stored plasma samples obtained pre‐transplantation at day –23 (±15 days) and post‐transplantation at day +28 (±3 days). Results Pre‐transplantation vitamin E levels were inversely associated with grade II–IV acute GvHD (hazard ratio 0.68 per 10 µmol/L increase, 95% confidence interval [CI]: 0.47‐0.98). The association remained after adjustment for known prognostic factors for acute GvHD. Patients with levels below the median had a cumulative incidence of grade II–IV acute GvHD of 46% (CI: 33‐59%) versus 21% (CI: 10‐32%) in patients with levels above the median. No clear association with non‐relapse mortality, relapse, or chronic GvHD was found. Post‐transplantation vitamin E levels (measured in 72 [63%] patients) were correlated with pre‐transplantation levels ( ρ  = .31) but were not associated with subsequent grade II–IV acute GvHD. Conclusions High pre‐transplantation vitamin E levels were associated with less acute GvHD.