In summary, elevated IgE in cGVHD was associated with increased levels of multiple immune cell subsets and immunoglobulins suggesting that IgE may be a marker of more robust post-transplant immune reconstitution. Prior history of asthma was associated with elevated IgE, indicating that pre-transplant factors may still influence IgE even years after transplant. Importantly, elevated IgE was not associated with any global or organ-specific measures of cGVHD severity or activ- ity or any acute phase reactants. These results suggest that in patients after allo-HSCT with cGVHD, elevated IgE is not a marker of disease or acute inflammation. CONFLICT OF INTEREST Nothing to report. Sencer Goklemez 1,2 , Filip Pirsl 1 , Lauren M. Curtis 1 , Seth M. Steinberg 3 , Edward W. Cowen 4 , Jacqueline W. Mays 5 , Meg Kenyon 1 , Judy Baruffaldi 1 , Fran T. Hakim 1 , Steven Z. Pavletic 1 1 Experimental Transplantation and Immunology Branch, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland 2 Koç University School of Medicine, Istanbul, Turkey 3 Biostatistics and Data Management Section, NCI, NIH, Bethesda, Maryland 4 Dermatology Branch, NCI, NIH, Bethesda, Maryland 5 National Institute of Dental and Craniofacial Research, NIH, Bethesda, Maryland Correspondence Steven Z. Pavletic, MD, MS, Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Room 3E3330, 10 Center Drive, Bethesda, Maryland, 20892-1203, USA. Email: pavletis@mail.nih.gov REFERENCES [1] Cooke KR, Luznik L, Sarantopoulos S, et al. The biology of chronic graft- versus-host disease: a task force report from the National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease. Biol Blood Marrow Transplant. 2016;23:211–234. [2] Hakim FT, Memon S, Jin P, et al. Upregulation of IFN-inducible and damage-response pathways in chronic graft-versus-host disease. J Immunol. 2016;197:3490–3503. [3] Ringd en O, Persson U, Johansson S. Are increased IgE-levels a signal of an acute graft-versus-host reaction? Immunol Rev. 1983; 71:57–76. [4] Dema B, Pellefigues C, Hasni S, et al. Autoreactive IgE is preva- lent in systemic lupus erythematosus and is associated with increased disease activity and nephritis. PLoS One. 2014;9: e90424. [5] Fairley JA, Baum CL, Brandt DS, et al. Pathogenicity of IgE in autoim- munity: successful treatment of bullous pemphigoid with omalizumab. J Allergy Clin Immunol. 2009;123:704–705. [6] Filipovich AH, Weisdorf D, Pavletic S, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease. I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005;11: 945–956. SUPPORTING INFORMATION Additional Supporting Information may be found online in the supporting information tab for this article. SUPPORTING INFORMATION TABLE I Patient Demographics. SUPPORTING INFORMATION TABLE II Chronic GVHD Characteristics. SUPPORTING INFORMATION FIGURE 1 Distribution of IgE values in chronic GVHD patients. SUPPORTING INFORMATION FIGURE 2 Overall survival in chronic GVHD patients based on IgE levels. Received: 3 April 2017 | Revised: 11 April 2017 | Accepted: 12 April 2017 DOI 10.1002/ajh.24765 High prevalence of monoclonal gammopathy among patients with warm autoimmune hemolytic anemia To the Editor: Several observational studies have shown that patients with auto- immune disorders have a higher risk of a subsequent diagnosis of monoclonal gammopathy which includes monoclonal gammopathy of undetermined significance and lymphoplasmacytic malignancies (LPMs). 1 However, it is unclear whether autoimmunity precedes the development of a lymphoplasmacytic clone or if a pre-existing lymphoplasmacytic clone triggers autoimmune hemolysis. The latter may be especially true for monoclonal gammopathy of undetermined significance since screen- ing for monoclonal gammopathy is not a routine practice and often is performed only once when an LPM is suspected based on clinical findings. It is possible that monoclonal gammopathy may precede an autoimmune disorder years before the former is recognized and the monoclonal protein may interact with a self-antigen inducing or playing a causal role in autoimmunity. In fact, there is a growing list of auto- immune disorders that are known to be associated with or caused by monoclonal gammopathy. These include acquired angioedema, 2 C3 glomerulonephritis, 3 cold agglutinin disease, 4 cryoglobulinemia, 5 sclero- myxedema, 6 and acquired von Willebrand syndrome. 7 We have been interested in the possible association of monoclonal gammopathy and LPM in hemolytic anemias. While the association of monoclonal gamm- opathy with cold agglutinin disease is well described in the literature, 4 the association of monoclonal gammopathy with warm autoimmune hemolytic anemia (WAIHA) is unknown. To evaluate any possible association of monoclonal gammopathy with WAIHA, we performed a retrospective review of all adult (age 18 years) patients with WAIHA seen at the Mayo Clinic from January 1, 1990 to March 31, 2016. WAIHA was defined as the presence of all of the following based on previously published criteria: (a) warm antibody (direct anti-globulin test (DAT) showing IgG 6 C3d and absence of cold agglutinin); (b) biochemical evidence of hemolysis (elevated lactate dehy- drogenase, decreased haptoglobin, and/or elevated indirect bilirubin); and (c) anemia (hemoglobin <12 g/dL). 8 To determine the prevalence of E164 | AJH AJH RAVINDRAN ET AL