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Prepublished online as a Blood First Edition Paper on April 24, 2003; DOI 10.1182/blood-2002-10-3141.
Submitted October 17, 2002
Accepted March 14, 2003
Performance of a new clinical grading system for chronic graft-versus-host disease: a multi-center study
Gorgun 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*
Department of Oncology, The Johns Hopkins University, Baltimore, MD, USA
The IBMTR GVHD Working Group, Milwaukee, WI, USA
Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
University of Minnesota Medical Center, Minneapolis, MN, USA
* Corresponding author; email: vogelge{at}jhmi.edu.
We recently reported three risk factors (RFs) at diagnosis of chronic graft-versus-host disease (cGVHD) that were significantly associated with increased non-relapse 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 equals or greater than 2 (high-risk; more than 1 RF) compared to intermediate-risk group was 6.9 (3.8, 12.4). A rare presentation of TP and PTO without ESI yielded PS of 1.8 (intermediate-risk). This paper reports the performance of the prognostic model and the individual RFs using data from additional 1105 patients from University of Nebraska (n=60), International BMT Registry (n=708), Fred Hutchinson CRC (n=188), and University of Minnesota (n=149). The extent of skin involvement was quantified in three cohorts using the available data collected in different formats before the analysis. While the HR for mortality of the patients in intermediate-risk group vs. those in favorable-risk group ranged from 2.3 to 8.9 across the centers; it was between 1.6 to 6.9 for patients in high-risk group vs. those in intermediate-risk group. While TP itself was uniformly associated with increased risk of mortality across all test samples, ESI and PTO showed statistically significant associations with mortality in one and two 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 to the learning sample. While the new clinical grading based on the model is promising because of its utility across multiple independent data sets, prospective validation is needed.
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