|
|
Prepublished online as a Blood First Edition Paper on April 24, 2003; DOI 10.1182/blood-2002-10-3141.
 Previous Article | Table of Contents | Next Article 
Blood, 1 August 2003, Vol. 102, No. 3, pp. 802-809
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Performance of a new clinical grading system for chronic graft-versus-host disease: a multicenter study
Görgün Akpek,
Stephanie J. Lee,
Mary E. Flowers,
Steven Z. Pavletic,
Mukta Arora,
Shing Lee,
Steven Piantadosi,
Katherine A. Guthrie,
James C. Lynch,
Alessandra Takatu,
Mary M. Horowitz,
Joseph H. Antin,
Daniel J. Weisdorf,
Paul J. Martin, and
Georgia B. Vogelsang
From the Department of Oncology, Johns Hopkins University, Baltimore, MD; International Bone Marrow Transplantation Registry Graft-Versus-Host Disease Working Group, Milwaukee, WI; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Nebraska Medical Center, Omaha; and University of Minnesota, Minneapolis
We recently reported 3 risk factors (RFs) at diagnosis of chronic graft-versus-host disease (cGVHD) that were significantly associated with increased nonrelapse mortality. These included extensive skin involvement (ESI), thrombocytopenia (TP), and progressive type of onset (PTO). The hazard ratio (HR) for mortality of the patients with prognostic score (PS) between 0 and 2 (intermediate-risk; 1 RF) compared to those with PS 0 (favorable-risk; 0 RF) was 3.7 (95% CI, 1.4, 9.3); the HR for patients with PS equal to or more than 2 (high-risk; > 1 RF) compared with intermediate-risk group was 6.9 (3.8, 12.4). A rare presentation of TP and PTO without ESI yielded a PS of 1.8 (intermediate-risk). This paper reports the performance of the prognostic model and the individual RFs using data from an additional 1105 patients from University of Nebraska (n = 60), International Bone Marrow Transplantation Registry (n = 708), Fred Hutchinson Cancer Research Center (n = 188), and University of Minnesota (n = 149). The extent of skin involvement was quantified in 3 cohorts using the available data collected in different formats before the analysis. Although the HR for mortality of the patients in the intermediate-risk group versus those in the favorable-risk group ranged from 2.3 to 8.9 across the centers, it was between 1.6 to 6.9 for patients in the high-risk group versus those in the intermediate-risk group. Although TP itself was uniformly associated with increased risk of mortality across all test samples, ESI and PTO showed statistically significant associations with mortality in 1 and 2 cohorts, respectively. In conclusion, the model was predictive of cGVHD-specific survival, but the mortality hazard associated with ESI was lower in each of these test samples compared with the learning sample. Although the new clinical grading based on the model is promising because of its utility across multiple independent data sets, prospective validation is needed.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
J. S Bates, A. M. Engemann, and J. M Hammond
Clinical Utility of Rituximab in Chronic Graft-Versus-Host Disease
Ann. Pharmacother.,
February 1, 2009;
43(2):
316 - 321.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Dunbar, M. P. Buzzeo, J. B. Levine, J. D. Schold, H.-U. Meier-Kriesche, and V. Reddy
The relationship between circulating natural killer cells after reduced intensity conditioning hematopoietic stem cell transplantation and relapse-free survival and graft-versus-host disease
Haematologica,
December 1, 2008;
93(12):
1852 - 1858.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Shizuru
Of mice and men
Blood,
April 1, 2006;
107(7):
2589 - 2590.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. L. Stewart, B. Storer, J. Storek, H. J. Deeg, R. Storb, J. A. Hansen, F. R. Appelbaum, P. A. Carpenter, J. E. Sanders, H.-P. Kiem, et al.
Duration of immunosuppressive treatment for chronic graft-versus-host disease
Blood,
December 1, 2004;
104(12):
3501 - 3506.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. Kaplan, B. E. Anderson, J. M. McNiff, D. Jain, M. J. Shlomchik, and W. D. Shlomchik
Target Antigens Determine Graft-versus-Host Disease Phenotype
J. Immunol.,
November 1, 2004;
173(9):
5467 - 5475.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Miura, C. J. Thoburn, E. C. Bright, M. L. Phelps, T. Shin, E. C. Matsui, W. H. Matsui, S. Arai, E. J. Fuchs, G. B. Vogelsang, et al.
Association of Foxp3 regulatory gene expression with graft-versus-host disease
Blood,
October 1, 2004;
104(7):
2187 - 2193.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Bhushan and R. H. Collins Jr
Chronic Graft-vs-Host Disease
JAMA,
November 19, 2003;
290(19):
2599 - 2603.
[Full Text]
[PDF]
|
|
|
|
|
