Highlight
1. Three distinct biological subtypes of pediatric chronic graft-versus-host disease (cGvHD) identified: each characterized by unique immune cell and molecular patterns.
2. Subtype cGvHD-1 associates with effector memory T cells, cytotoxic NK cells, and early precursor B cells; subtype cGvHD-2 is enriched in phosphatidylcholine, cytokines, and plasma cells; subtype cGvHD-3 features naïve CD4+ and regulatory T cells with measurable T-cell receptor excision circles (TRECs).
3. Clinical correlations reveal subtype-specific associations with prior therapies, transplant characteristics, and disease presentations, suggesting implications for personalized therapeutic strategies.
4. Partial replication in an independent metabolomic pediatric cohort highlights robustness and potential for biomarker-based diagnostics.
