|
|
 Previous Article | Table of Contents | Next Article 
Blood, 1 March 2001, Vol. 97, No. 5, pp. 1219-1226
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Development of a prognostic model for grading chronic
graft-versus-host disease
Görgün Akpek,
Marianna L. Zahurak,
Steven Piantadosi,
Jeffrey Margolis,
Jon Doherty,
Robert Davidson, and
Georgia B. Vogelsang
From the Johns Hopkins Oncology Center, Division of
Hematologic Malignancies/BMT, and Oncology Biostatistics, Baltimore,
MD.
The disease-specific survival (DSS) of 151 patients with chronic
graft-versus-host disease (cGVHD) was studied in an attempt to stratify
patients into risk groups and to form a basis for a new grading of
cGVHD. The data included the outcome and 23 variables at the diagnosis
of cGVHD and at the primary treatment failure (PTF). Eighty-nine
patients (58%) failed primary therapy for cGVHD. Nonrelapse mortality
was 44% after a median follow-up of 7.8 years. The probability of DSS
at 10 years after diagnosis of cGVHD (DSS1) and after PTF (DSS2) was
51% (95% confidence interval [CI] = 39%, 60%) and 38% (95%
CI = 28%, 49%), respectively. According to multivariate analysis,
extensive skin involvement (ESI) more than 50% of body surface area;
hazard ratio (HR) of 7.0 (95% CI = 3.6-13.4), thrombocytopenia (TP)
(< 100 000/µL; HR, 3.6; 95% CI = 1.9-6.8), and progressive-type onset (PTO) (HR, 1.7; 95% CI = 0.9-3.0) significantly influenced DSS1. These 3 factors and Karnofsky Performance Score of less than 50%
at PTF were significant predictors for DSS2. The DSS1 at 10 years for
patients with prognostic factor score (PFS) at diagnosis of 0 (none),
less than 2 (ESI only or TP and/or PTO), 2 to 3.5 (ESI plus
either TP or PTO), and more than 3.5 (all 3 factors) was 82%, 68%,
34%, and 3% (P = .05, < .001, < .001), respectively.
The DSS2 at 5 years for patients with PFS at PTF of 0, 2 or less, 2 to
3.5, and more than 3.5 were 91%, 71%, 22%, and 4%
(P = .2, .005, and < .001), respectively. It was
concluded that these prognostic models might be useful in grouping the
patients with similar outcome.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
D. A. Jacobsohn, A. R. Chen, M. Zahurak, S. Piantadosi, V. Anders, J. Bolanos-Meade, M. Higman, J. Margolis, M. Kaup, and G. B. Vogelsang
Phase II Study of Pentostatin in Patients With Corticosteroid-Refractory Chronic Graft-Versus-Host Disease
J. Clin. Oncol.,
September 20, 2007;
25(27):
4255 - 4261.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Fraser, S. Bhatia, K. Ness, A. Carter, L. Francisco, M. Arora, P. Parker, S. Forman, D. Weisdorf, J. G. Gurney, et al.
Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study
Blood,
October 15, 2006;
108(8):
2867 - 2873.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Caballero, J. A. Garcia-Marco, R. Martino, V. Mateos, J. M. Ribera, J. Sarra, A. Leon, G. Sanz, J. de la Serna, R. Cabrera, et al.
Allogeneic Transplant with Reduced Intensity Conditioning Regimens may Overcome the Poor Prognosis of B-Cell Chronic Lymphocytic Leukemia with Unmutated Immunoglobulin Variable Heavy-Chain Gene and Chromosomal Abnormalities (11q- and 17p-)
Clin. Cancer Res.,
November 1, 2005;
11(21):
7757 - 7763.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. J. Clark, R. Gregg, K. Piper, D. Dunnion, L. Freeman, M. Griffiths, G. Begum, P. Mahendra, C. Craddock, P. Moss, et al.
Chronic graft-versus-host disease is associated with increased numbers of peripheral blood CD4+CD25high regulatory T cells
Blood,
March 15, 2004;
103(6):
2410 - 2416.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. D. Seaton, R. M. Szydlo, E. Kanfer, J. F. Apperley, and R. Russell-Jones
Influence of extracorporeal photopheresis on clinical and laboratory parameters in chronic graft-versus-host disease and analysis of predictors of response
Blood,
August 15, 2003;
102(4):
1217 - 1223.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Akpek, S. J. Lee, M. E. Flowers, S. Z. Pavletic, M. Arora, S. Lee, S. Piantadosi, K. A. Guthrie, J. C. Lynch, A. Takatu, et al.
Performance of a new clinical grading system for chronic graft-versus-host disease: a multicenter study
Blood,
August 1, 2003;
102(3):
802 - 809.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Socie, N. Salooja, A. Cohen, A. Rovelli, E. Carreras, A. Locasciulli, E. Korthof, J. Weis, V. Levy, and A. Tichelli
Nonmalignant late effects after allogeneic stem cell transplantation
Blood,
May 1, 2003;
101(9):
3373 - 3385.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zecca, A. Prete, R. Rondelli, E. Lanino, A. Balduzzi, C. Messina, F. Fagioli, F. Porta, C. Favre, A. Pession, et al.
Chronic graft-versus-host disease in children: incidence, risk factors, and impact on outcome
Blood,
July 30, 2002;
100(4):
1192 - 1200.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Lee, J. P. Klein, A. J. Barrett, O. Ringden, J. H. Antin, J.-Y. Cahn, M. H. Carabasi, R. P. Gale, S. Giralt, G. A. Hale, et al.
Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse
Blood,
June 28, 2002;
100(2):
406 - 414.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. E. D. Flowers, P. M. Parker, L. J. Johnston, A. V. B. Matos, B. Storer, W. I. Bensinger, R. Storb, F. R. Appelbaum, S. J. Forman, K. G. Blume, et al.
Comparison of chronic graft-versus-host disease after transplantation of peripheral blood stem cells versus bone marrow in allogeneic recipients: long-term follow-up of a randomized trial
Blood,
June 28, 2002;
100(2):
415 - 419.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Koc, W. Leisenring, M. E. D. Flowers, C. Anasetti, H. J. Deeg, R. A. Nash, J. E. Sanders, R. P. Witherspoon, R. Storb, F. R. Appelbaum, et al.
Therapy for chronic graft-versus-host disease: a randomized trial comparing cyclosporine plus prednisone versus prednisone alone
Blood,
June 17, 2002;
100(1):
48 - 51.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Wingard, G. B. Vogelsang, and H. J. Deeg
Stem Cell Transplantation: Supportive Care and Long-Term Complications
Hematology,
January 1, 2002;
2002(1):
422 - 444.
[Abstract]
[Full Text]
|
|
|
| |
