Graft-versus-host disease, but not graft-versus-leukemia immunity, is mediated by GM-CSF-licensed myeloid cells

Sci Transl Med. 2018 Nov 28;10(469):eaat8410. doi: 10.1126/scitranslmed.aat8410.


Allogeneic hematopoietic cell transplantation (allo-HCT) not only is an effective treatment for several hematologic malignancies but can also result in potentially life-threatening graft-versus-host disease (GvHD). GvHD is caused by T cells within the allograft attacking nonmalignant host tissues; however, these same T cells mediate the therapeutic graft-versus-leukemia (GvL) response. Thus, there is an urgent need to understand how to mechanistically uncouple GvL from GvHD. Using preclinical models of full and partial MHC-mismatched HCT, we here show that the granulocyte-macrophage colony-stimulating factor (GM-CSF) produced by allogeneic T cells distinguishes between the two processes. GM-CSF drives GvHD pathology by licensing donor-derived phagocytes to produce inflammatory mediators such as interleukin-1β and reactive oxygen species. In contrast, GM-CSF did not affect allogeneic T cells or their capacity to eliminate leukemic cells, retaining undiminished GvL responses. Last, tissue biopsies and peripheral blood mononuclear cells from patients with grade IV GvHD showed an elevation of GM-CSF-producing T cells, suggesting that GM-CSF neutralization has translational potential in allo-HCT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Graft vs Host Disease / immunology*
  • Graft vs Host Disease / pathology
  • Granulocyte-Macrophage Colony-Stimulating Factor / pharmacology*
  • Hematopoietic Stem Cell Transplantation
  • Histocompatibility Antigens / metabolism
  • Humans
  • Immunity / drug effects*
  • Interferon-gamma / metabolism
  • Leukemia / immunology*
  • Mice, Inbred BALB C
  • Mice, Inbred C57BL
  • Myeloid Cells / drug effects
  • Myeloid Cells / metabolism*
  • T-Lymphocytes / drug effects
  • T-Lymphocytes / immunology
  • Transplantation, Homologous


  • Histocompatibility Antigens
  • Interferon-gamma
  • Granulocyte-Macrophage Colony-Stimulating Factor