Monocyte subsets in bone marrow grafts may contribute to a low incidence of acute graft-vs-host disease for young donors.

Young donors are associated with a lower cumulative incidence of acute graft-vs-host disease (aGVHD) after allogenic haematopoietic stem cell transplantation (allo-HSCT) than old donors. Although grafts are harvested from healthy donors, it is unclear whether donor age is associated with aGVHD occurrence owing to its effect on cell compositions in grafts. Moreover, the differences in monocyte subsets in grafts between young and old donors and the association between monocyte subsets in bone marrow (BM) grafts and aGVHD remain to be elucidated. In the current study, non-classical monocytes and the CD4 /CD8 T cell ratio were remarkably decreased in BM grafts in donors <30 years old. Multivariate analysis further revealed that the level of non-classical monocytes in BM grafts (≥0.31 × 10 /kg) was an independent risk factor for the occurrence of II-IV aGVHD. In summary, our data indicate that non-classical monocytes in BM grafts may help identify patients at high risk for aGVHD after allo-HSCT. Although further validation is required, our results suggest that the low level of non-classical monocytes and a low ratio of CD4 /CD8 T cell in BM grafts may be correlated with the lower incidence of aGVHD in young donors.