Relation between tumour necrosis factor alpha and graft versus host disease in allogeneic bone marrow transplantation

Tumour necrosis factor alpha (TNF-alpha) was measured in the sera of 19 patients pre- and weekly post-allogeneic bone marrow transplantation (BMT). All marrow donors were HLA identical siblings. The level was elevated in seven cases and five of them developed severe acute graft versus host disease (aGVHD) grade 3 and 4. This relation was statistically significant (p = 0.008). 12 patients had undetectable TNF-alpha pre- and post BMT, four patients developed grade 1 and 2 and one patient grade 4 aGVHD. The probability of developing aGVHD versus no GVHD among patients with undetectable TNF-alpha was not statistically significant (p = 0.72). TNF-alpha levels were elevated pre transplant in four out of six patients who developed severe aGVHD. This fact may point to TNF-alpha as a strong predictor of severe aGVHD in allogeneic BMT.