TY - JOUR
T1 - A refined risk score for acute graft-versus-host disease that predicts response to initial therapy, survival, and transplant-related mortality
AU - MacMillan, Margaret L.
AU - Robin, Marie
AU - Harris, Andrew C.
AU - DeFor, Todd E.
AU - Martin, Paul J.
AU - Alousi, Amin
AU - Ho, Vincent T.
AU - Bolaños-Meade, Javier
AU - Ferrara, James L.M.
AU - Jones, Richard
AU - Arora, Mukta
AU - Blazar, Bruce R.
AU - Holtan, Shernan G.
AU - Jacobsohn, David
AU - Pasquini, Marcelo
AU - Socie, Gerard
AU - Antin, Joseph H.
AU - Levine, John E.
AU - Weisdorf, Daniel J.
N1 - Publisher Copyright:
© 2015 American Society for Blood and Marrow Transplantation.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - To develop a novel acute graft-versus-host disease (GVHD) risk score, we examined the GVHD clinical stage and grade of 1723 patients at the onset of treatment with systemic steroids. Using clinical grouping, descriptive statistics and recursive partitioning, we identified poorly responsive, high-risk (HR) acute GVHD by the number of involved organs and severity of GVHD at onset. The overall response (complete response/partial response) rate 28 days after initiation of steroid therapy for acute GVHD was lower in the 269 patients with HR-GVHD than in the 1454 patients with standard risk (SR)-GVHD (44% [95% confidence interval (CI) 38% to 50%] versus 68% [95% CI, 66% to 70%], P < .001). Patients with HR-GVHD were less likely to respond at day 28 (odds ratio [OR], .3; 95% CI, .2 to .4; P < .001) and had higher risks of mortality (relative risk, 2.1; 95% CI, 1.7 to 2.6; P < .001) and transplant-related mortality (relative risk, 2.5; 95% CI, 2.0% to 3.2%, P < .001) than patients with SR-GVHD. This refined definition of acute GVHD risk is a better predictor of response, survival, and transplant-related mortality than other published acute GVHD risk scores. Patients with HR-GVHD are candidates for studies investigating new treatment approaches. Likewise, patients with SR-GVHD are candidates for studies investigating less toxic therapy.
AB - To develop a novel acute graft-versus-host disease (GVHD) risk score, we examined the GVHD clinical stage and grade of 1723 patients at the onset of treatment with systemic steroids. Using clinical grouping, descriptive statistics and recursive partitioning, we identified poorly responsive, high-risk (HR) acute GVHD by the number of involved organs and severity of GVHD at onset. The overall response (complete response/partial response) rate 28 days after initiation of steroid therapy for acute GVHD was lower in the 269 patients with HR-GVHD than in the 1454 patients with standard risk (SR)-GVHD (44% [95% confidence interval (CI) 38% to 50%] versus 68% [95% CI, 66% to 70%], P < .001). Patients with HR-GVHD were less likely to respond at day 28 (odds ratio [OR], .3; 95% CI, .2 to .4; P < .001) and had higher risks of mortality (relative risk, 2.1; 95% CI, 1.7 to 2.6; P < .001) and transplant-related mortality (relative risk, 2.5; 95% CI, 2.0% to 3.2%, P < .001) than patients with SR-GVHD. This refined definition of acute GVHD risk is a better predictor of response, survival, and transplant-related mortality than other published acute GVHD risk scores. Patients with HR-GVHD are candidates for studies investigating new treatment approaches. Likewise, patients with SR-GVHD are candidates for studies investigating less toxic therapy.
KW - Allogeneic hematopoietic cell transplantation
KW - Grading systems
KW - Graft-versus-host disease
KW - Risk score
KW - Survival
KW - Transplant-related mortality
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U2 - 10.1016/j.bbmt.2015.01.001
DO - 10.1016/j.bbmt.2015.01.001
M3 - Article
C2 - 25585275
AN - SCOPUS:84924230138
SN - 1083-8791
VL - 21
SP - 761
EP - 767
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 4
ER -