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Chronic graft-versus-host disease (cGVHD) is a major complication following unmanipulated haploidentical hematopoietic stem cell transplantation (haplo-HSCT).We aimed to identify the risk factors for cGVHD in patients who underwent anti-thymocyte globulin-based haplo-HSCT for acute myeloid leukemia (n =280).The diagnosis of cGVHD was in accordance with the National Institutes of Health consensus criteria.A total of 169 patients suffered from cGVHD.The patients who had 3 loci mismatched had a higher 8-year incidence of cGVHD (total,66.0％ vs.53.7％,P=0.031;moderate to severe,42.4％ vs.30.1％,P=0.036) than the patients who had 1 to 2 loci mismatched.The patients who had mateal donors had a higher 8-year incidence of moderate to severe cGVHD (49.2％ vs.32.9％,P =0.024) compared with the patients who had other donors.The patients who had grades Ⅲ to Ⅳ acute GVHD (aGVHD) had higher 8-year incidence of cGVHD (total,88.0％ vs.50.4％,P ＜ 0.001;moderate to severe,68.0％ vs.27.0％,P ＜ 0.001) compared with the patients without aGVHD.In multivariate analysis,grades Ⅲ to Ⅳ aGVHD was the only independent risk factor for cGVHD.Thus,further interventions should be considered in patients with severe aGVHD to prevent cGVHD.