Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis
Mukta Arora1, John P Klein, Daniel J Weisdorf
1Department of Hematology, Oncology and Transplant, University of Minnesota, 420 Delaware St SE, Minneapolis MN 55455, USA. arora005@umn.edu
Insights
A new risk score for chronic graft-versus-host disease (cGVHD) was developed using 10 variables from 5343 patients. This score identifies 6 risk groups, aiding in predicting patient outcomes after transplantation.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Chronic graft-versus-host disease (cGVHD) is a significant complication following allogeneic stem cell transplantation.
- Identifying reliable prognostic factors for cGVHD outcomes is crucial for patient management and risk stratification.
Purpose of the Study:
- To develop and validate a comprehensive risk score for predicting overall survival and nonrelapse mortality (NRM) in patients with cGVHD.
Main Methods:
- A multivariate analysis was performed on data from 5343 patients with cGVHD.
- Ten significant variables were identified: age, prior acute GVHD, time to cGVHD, donor type, disease status, GVHD prophylaxis, gender mismatch, bilirubin, Karnofsky score, and platelet count.
- These variables were used to create a cGVHD risk score, categorizing patients into 6 distinct risk groups (RGs).
Main Results:
- The 5-year nonrelapse mortality (NRM) ranged from 5% in RG1 to 72% in RG6.
- The 5-year overall survival varied significantly across the risk groups, with RG1 showing 91% survival and RG6 showing 4% survival.
- A clear gradient of outcomes was observed across the 6 identified risk groups (all P < .01).
Conclusions:
- The developed cGVHD risk score effectively stratifies patients into distinct prognostic categories.
- This risk score, derived from a large patient registry, can aid in predicting major transplantation outcomes.
- Further validation in independent populations is recommended to confirm the broad applicability of this cGVHD risk score.
Abstract:
Several risk factors are associated with increased mortality in patients with chronic graft-versus-host disease (cGVHD), but there is considerable variability in the reported factors. Therefore, we evaluated patient, transplantation, and cGVHD characteristics to develop a risk score in 5343 patients with cGVHD. Ten variables were identified as being significant in multivariate analysis of overall survival and nonrelapse mortality (NRM): age, prior acute GVHD, time from transplantation to cGVHD, donor type, disease status at transplantation, GVHD prophylaxis, gender mismatch, serum bilirubin, Karnofsky score, and platelet count. These 10 variables were used to build a cGVHD risk score, and 6 risk groups (RGs) were identified. The 5-year NRM was 5% (1%-9%) in RG1, 20% (19%-23%) in RG2, 33% (29%-37%) in RG3, 43% (40%-46%) in RG4, 63% (53%-74%) in RG5, and 72% (59%-85%) in RG6. The 5-year overall survival was highest at 91% (95% confidence interval [CI]:85%-97%) in RG1, followed by 67% (65%-69%) in RG2, 51% (46%-55%) in RG3, 40% (37%-43%) in RG4, 21% (12%-30%) in RG5, and 4% (0%-9%) in RG6 (all P < .01). This analysis demonstrates the usefulness of data from a large registry to develop risk-score categories for major transplantation outcomes. Validation of this cGVHD risk score is needed in a different population to ensure its broad applicability.
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