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Gastrointestinal involvement refines prognosis in minnesota standard risk acute graft-vs.-host disease
Curtis M Marcoux1, Amin M Alousi2, Jin Im3
1Division of Hematology, Dalhousie University, Halifax, NS, Canada.
Abstract:
Minnesota acute graft versus host disease (AGVHD) risk score is a validated tool to stratify newly-diagnosed patients into standard-risk (SR) and high-risk (HR) groups with ~85% having SR AGVHD. We aimed to identify factors for further risk-stratification within Minnesota SR patients. A single-center, retrospective analysis of consecutive patients between 1/2010 and 12/2014 was performed. Patients who developed AGVHD within 100 days and treated with systemic corticosteroids were included (N = 416), 356 (86%) of which were Minnesota SR and 60 (14%) had HR AGVHD. Isolated upper gastrointestinal (GI) AGVHD patients had significantly better day 28 and 56 CR/PR rates (90% vs. 72%, p = 0.004) and (83% vs 66%, p = 0.01), respectively, and lower 1-year non-relapse mortality (NRM; 10% vs. 22%; HR 0.4, p = 0.03). Lower GI AGVHD had less favorable outcomes with 1-year NRM of 40% (HR 2.1, p = 0.001), although CR/PR rates were not statistically different. In multivariate analysis, lower GI involvement (HR 2.6, p < 0.001), age ≥ 50 (HR 2.9, p < 0.001) and HCT-CI > 3 (HR 2.1, p = 0.002) predicted for 1-year NRM. Heterogeneity within Minnesota SR patients requires consideration in clinical trials, as distinct outcomes are observed in those with isolated upper GI and lower GI AGVHD, highlighting the importance of stratification in clinical trial design.
Insights
Further risk stratification is needed within standard-risk acute graft-versus-host disease (AGVHD) patient groups. Lower gastrointestinal AGVHD, older age, and higher HCT-CI scores predict worse outcomes.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- The Minnesota acute graft-versus-host disease (AGVHD) risk score stratifies patients into standard-risk (SR) and high-risk (HR) groups.
- Approximately 85% of newly-diagnosed patients fall into the SR category.
Purpose of the Study:
- To identify factors for further risk stratification within the Minnesota SR AGVHD patient cohort.
- To analyze the impact of AGVHD location on treatment outcomes.
Main Methods:
- Retrospective analysis of 416 patients diagnosed with AGVHD between January 2010 and December 2014.
- Included patients developed AGVHD within 100 days and received systemic corticosteroid treatment.
- Stratified patients based on AGVHD location (upper vs. lower GI) and Minnesota risk score (SR vs. HR).
Main Results:
- Isolated upper GI AGVHD showed significantly better response rates (CR/PR) and lower 1-year non-relapse mortality (NRM) compared to lower GI AGVHD.
- Lower GI AGVHD was associated with higher 1-year NRM (40%).
- Multivariate analysis identified lower GI involvement (HR 2.6), age ≥ 50 (HR 2.9), and HCT-CI > 3 (HR 2.1) as predictors for 1-year NRM.
Conclusions:
- Significant heterogeneity exists within the Minnesota SR AGVHD patient group.
- Distinct outcomes based on AGVHD location (upper vs. lower GI) necessitate consideration in clinical trial design.
- Further stratification of SR AGVHD patients is crucial for optimizing treatment strategies and clinical trial enrollment.
