Clinical characteristics and risk factors of acute cutaneous graft-vs.-host disease following allogeneic hematopoietic stem cell transplantation in pediatric acute myeloid leukemia: a single-center retrospective study.

OBJECTIVE: To analyze clinical characteristics and risk factors of acute cutaneous graft-vs.-host disease (GVHD) in pediatric acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT), providing evidence for clinical risk stratification and individualized prophylaxis. METHODS: A retrospective cohort study included pediatric AML patients who underwent their first allo-HSCT at Hunan Children's Hospital between July 1, 2022 and December 31, 2024. Demographic, disease-related, donor-recipient matching, transplant procedure, and supportive care data were collected. The primary outcome was acute cutaneous GVHD within 100 days post-transplant. Univariate analysis identified potential risk factors, and multivariate logistic regression confirmed independent predictors, with sensitivity analysis verifying robustness. RESULTS: Acute cutaneous GVHD occurred in 27 pediatric patients (38.6%), including grade I (14.8%, 4/27), II (59.3%, 16/27), and III (25.9%, 7/27) cases. Multivariate analysis showed HLA mismatch at ≥2/10 alleles (OR = 4.26, 95%CI:1.68-10.82, P = 0.002), refractory/relapsed disease pre-transplant (OR = 6.83, 95%CI:1.57-29.65, P = 0.011), and myeloablative conditioning (MAC) (OR = 3.15, 95%CI:1.08-9.19, P = 0.036) were independent risk factors. Sensitivity analysis confirmed result robustness, and subgroup analysis showed stronger associations with grade II-III aGVHD. CONCLUSION: Poor HLA matching, refractory/relapsed disease pre-transplant, and MAC increase the risk of acute cutaneous GVHD in pediatric AML patients after allo-HSCT. The risk factors identified in this study are helpful for identifying high-risk pediatric AML patients before transplantation, providing a basis for implementing individualized GVHD prevention strategies.