title: Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis.
abstract: Several risk factors are associated with increased mortality in patients with chronic graft-versus-host disease (cGVHD), but there is considerable variability in the reported factors. Therefore, we evaluated patient, transplantation, and cGVHD characteristics to develop a risk score in 5343 patients with cGVHD. Ten variables were identified as being significant in multivariate analysis of overall survival and nonrelapse mortality (NRM): age, prior acute GVHD, time from transplantation to cGVHD, donor type, disease status at transplantation, GVHD prophylaxis, gender mismatch, serum bilirubin, Karnofsky score, and platelet count. These 10 variables were used to build a cGVHD risk score, and 6 risk groups (RGs) were identified. The 5-year NRM was 5% (1%-9%) in RG1, 20% (19%-23%) in RG2, 33% (29%-37%) in RG3, 43% (40%-46%) in RG4, 63% (53%-74%) in RG5, and 72% (59%-85%) in RG6. The 5-year overall survival was highest at 91% (95% confidence interval [CI]:85%-97%) in RG1, followed by 67% (65%-69%) in RG2, 51% (46%-55%) in RG3, 40% (37%-43%) in RG4, 21% (12%-30%) in RG5, and 4% (0%-9%) in RG6 (all P < .01). This analysis demonstrates the usefulness of data from a large registry to develop risk-score categories for major transplantation outcomes. Validation of this cGVHD risk score is needed in a different population to ensure its broad applicability.
authors.affiliation: Department of Hematology, Oncology and Transplant, University of Minnesota, 420 Delaware St SE, Minneapolis MN 55455, USA. arora005@umn.edu
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Anna
authors.initials: A
authors.lastname: Hassebroek
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano-Ispizua
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.forename: Michael
authors.initials: M
authors.lastname: Boyiadzis
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: David A
authors.initials: DA
authors.lastname: Jacobsohn
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
authors.forename: Stella
authors.initials: S
authors.lastname: Santarone
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.forename: Stephen
authors.initials: S
authors.lastname: Spellman
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D035843:Biomedical Research / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007390:International Agencies; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D012042:Registries / Q000706:statistics & numerical data; D012107:Research Design; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D055815:Young Adult