title: Association of severity of organ involvement with mortality and recurrent malignancy in patients with chronic graft-versus-host disease.
abstract: The National Institutes of Health global score for chronic graft-versus-host disease was devised by experts but was not based on empirical data. We hypothesized that analysis of prospectively collected data would enable derivation of a more accurate model for estimating mortality risk. We analyzed 574 adult patients with chronic graft-versus-host disease enrolled in a multicenter, observational study, using multivariate time-varying analysis accounting for serial changes in severity of involvement of eight individual organ sites over time. In the training set, severity of skin, mouth, gastrointestinal tract, liver and lung involvement were independently associated with the risk of non-relapse mortality. Weighted mortality points were assigned to individual organs based on the hazard ratios and were summed. The population was divided into three risk groups based on the total mortality points. The three new risk groups were validated in an independent validation set, but did not show better discriminative performance than the National Institutes of Health global score. As compared to a moderate or mild global score, a severe global score was associated with increased risks of non-relapse and overall mortality across time but not with a decreased risk of recurrent malignancy. The National Institutes of Health global score predicts patients' mortality risk throughout the course of their chronic graft-versus-host disease. Further research is required in order to improve outcomes in patients with severe chronic graft-versus-host disease, since their risk of mortality remains elevated.
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA yinamoto@fhcrc.org.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.affiliation: Division of Hematology and Oncology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pidala
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Hematology and Stem Cell Transplant Program, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Arai
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Chai
authors.affiliation: National Cancer Institute, Bethesda, MD, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
authors.affiliation: Oncology, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Georgia B
authors.initials: GB
authors.lastname: Vogelsang
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009364:Neoplasm Recurrence, Local; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D012720:Severity of Illness Index; D055815:Young Adult