Related Experiment Video
Updated: Nov 22, 2025
Induction of Intestinal Graft-versus-host Disease and Its Mini-endoscopic Assessment in Live Mice
Published on: February 11, 2019
Refined hepatic grading system in chronic graft-versus-host disease improves prognostic risk stratification of
Igor Novitzky-Basso1, Saud AlHayli1, Elizabeth Shin1
1Department of Medical Oncology and Hematology, Hans Messner Allogeneic Stem Cell Transplant Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.
Insights
A new refined hepatic score (RHS) effectively stratifies patients with chronic graft-versus-host disease (cGvHD) and liver involvement. This score predicts long-term overall survival (OS) and non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplant.
Area of Science:
- Hematology
- Transplantation immunology
- Hepatology
Background:
- Current hepatic grading systems for chronic graft-versus-host disease (cGvHD) lack objective criteria.
- Arbitrary grading systems hinder accurate prognosis prediction in cGvHD patients with liver involvement.
Purpose of the Study:
- To establish objective cutoff values for liver function tests in cGvHD.
- To develop a refined hepatic grading score (RHS) for predicting prognosis in cGvHD.
Main Methods:
- Evaluation of overall survival (OS) and non-relapse mortality (NRM) in 336 cGvHD patients post-allogeneic hematopoietic stem cell transplant (HCT).
- Statistical analysis using predictive values (NPV, PPV) and accuracy to determine optimal cutoff values for liver enzymes and bilirubin.
- Development and validation of the Refined Hepatic Score (RHS).
Main Results:
- Alkaline phosphatase (ALP) ≥ 146 IU/L and bilirubin ≥ 14 µmol/L significantly correlated with OS.
- The RHS stratified patients into low-risk (score 0) and high-risk (score 1-2) groups.
- Low-RHS group showed 80.5% OS at 3 years vs. 62.7% in high-RHS group; NRM was 11.9% vs. 19.6% respectively.
Conclusions:
- The Refined Hepatic Score (RHS) demonstrates significant potential for stratifying cGvHD patients with liver involvement.
- RHS provides objective criteria for predicting long-term outcomes, including OS and NRM.
- This scoring system can aid in clinical decision-making and patient management.
Objectives:
Hepatic grading systems for categorizing severity in chronic graft-versus-host disease (cGvHD) were determined arbitrarily, leading us to initiate the present study to provide objective evidence for the determination of optimal cutoff values and devise a hepatic grading system to predict prognosis.
Methods:
Of 842 patients who received allogeneic hematopoietic stem transplant (HCT), 336 patients diagnosed with cGvHD were evaluated for overall survival (OS) and non-relapse mortality (NRM) after cGVHD development. Multiple statistical parameters were evaluated to define optimal cutoff values of liver profile, including negative predictive value (NPV), positive predictive value (PPV), accuracy, and p-values as measures of risk stratification power.
Results:
We found that alkaline phosphatase (ALP) ≥ 146 IU/L (NPV: 83.4%; PPV: 32.8%; accuracy: 52.7%) and bilirubin ≥ 14 µmol/L (NPV: 81.8%; PPV: 39.4%; accuracy 68.1%) significantly correlated with OS. We developed a refined hepatic cGvHD grading score (RHS), stratifying patients into a low-RHS group with RHS score 0, OS at 3 years (n = 162) to 80.5%, compared to high-RHS group with score 1-2 (n = 172) 62.7%. Regarding NRM, score 0 segregated NRM at 3 years to 11.9%, compared with score 1-2 19.6%, P = .1.
Conclusions:
Refined hepatic score is promising for stratifying patients with cGVHD and liver involvement according to long-term outcomes.
Related Concept Videos
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow