title: Evaluation of prognostic factors among patients with chronic graft-versus-host disease.
abstract: BACKGROUND
  Chronic graft-versus-host disease (cGVHD) is a major complication after allogeneic stem cell transplantation with an adverse effect on both mortality and morbidity. In 2005, the National Institute of Health proposed new criteria for diagnosis and classification of chronic graft-versus-host disease for clinical trials. New sub-categories were recognized such as late onset acute graft-versus-host disease and overlap syndrome.
  
  
  METHODS
  We evaluated the prognostic impact of the new sub-categories as well as the clinical scoring system proposed by the National Institute of Health in a retrospective, multicenter study of 820 patients undergoing allogeneic stem cell transplantation between 2000 and 2006 at 3 different institutions. Patients were retrospectively categorized according to the National Institute of Health criteria from patients' medical histories.
  
  
  RESULTS
  As far as the new sub-categories are concerned, in univariate analysis diagnosis of overlap syndrome adversely affected the outcome. Also, the number of organs involved for a cut-off value of 4 significantly influenced both cGVHD related mortality and survival. In multivariate analysis, in addition to NIH score, platelet count and performance score at the time of cGVHD diagnosis, plus gut involvement, significantly influenced outcome. These 3 variables allowed us to develop a simple score system which identifies 4 subgroups of patients with 84%, 64%, 43% and 0% overall survival at five years after cGVHD diagnosis (score 0: HR=15.96 (95% CI: 6.85-37.17), P<0.001; score 1: HR=5.47 (95% CI: 2.6-11.5), P<0.001; score 2: HR=2.8 (95% CI: 1.32-5.93), P=0.007).
  
  
  CONCLUSIONS
  In summary, we have identified a powerful and simple tool to discriminate different subgroups of patients in terms of chronic graft-versus-host disease related mortality and survival.
authors.affiliation: Servicio de Hematología, Hospital Universitario de Salamanca, IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain. josea.perez.simon.sspa@juntade-andalucia.es
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pérez-Simón
authors.forename: Gabriel
authors.initials: G
authors.lastname: Afram
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Jose L
authors.initials: JL
authors.lastname: Piñana
authors.forename: Teresa
authors.initials: T
authors.lastname: Caballero-Velazquez
authors.forename: Olle
authors.initials: O
authors.lastname: Ringden
authors.forename: David
authors.initials: D
authors.lastname: Valcarcel
authors.forename: Dolores
authors.initials: D
authors.lastname: Caballero
authors.forename: Mats
authors.initials: M
authors.lastname: Remberger
authors.forename: Yanira
authors.initials: Y
authors.lastname: de Paz
authors.forename: Jordi
authors.initials: J
authors.lastname: Sierra
authors.forename: Jesús San
authors.initials: JS
authors.lastname: Miguel
authors.forename: Hans
authors.initials: H
authors.lastname: Hagglund
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult