Serum thioredoxin at allogeneic haematopoietic stem cell transplantation predicts acute graft-versus-host disease

Thioredoxin (TXN) is a component of a major reductive system in various eukaryotes. Although oxidative stress is considered to contribute to the development of acute graft-versus-host disease (GVHD), the clinical significance of TXN remains to be elucidated. The current study included 118 patients who had undergone their first allogeneic haematopoietic stem cell transplantation (allo-HSCT) between 2022 and 2025, and their serum samples at day 0 were sequentially collected (training cohort). The study also assessed 47 patients who had undergone their first allo-HSCT between 2012 and 2015 and whose serum at around day 0 had previously been cryopreserved and was available (validation cohort). The high-TXN group showed a lower cumulative incidence of grade II-IV acute GVHD (100-day incidence: 47.5% vs. 59.2%), although the difference did not reach statistical significance (p = 0.058). The validation cohort demonstrated similar results (0% vs. 35.8%, p = 0.053). However, multivariate analysis revealed that high-TXN group was significantly associated with a reduced risk of acute GVHD (hazard ratio [HR] 0.48, p = 0.031). In addition, the combination of TXN with clinical factors enhanced the predictive potential for acute GVHD compared with that of clinical factors alone (p = 0.0039). TXN might be useful for predicting acute GVHD and could contribute to the establishment of a prediction model.