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What predicts high risk acute graft‐ versus ‐host disease ( GVHD ) at onset?: identification of those at highest risk by a novel acute GVHD risk score
Author(s) -
MacMillan Margaret L.,
DeFor Todd E.,
Weisdorf Daniel J.
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2012.09114.x
Subject(s) - medicine , graft versus host disease , gastroenterology , prednisone , disease , surgery
Summary To define high‐risk acute graft‐ versus ‐host disease ( GVHD ) at onset, we examined the initial GVHD stage and grade of 864 patients at the U niversity of M innesota who received uniform therapy with prednisone 60 mg/m 2 per d. We compared the prognostic utility of the M innesota ( MN ; modified from C onsensus) versus C enter for I nternational B lood and M arrow T ransplant R esearch ( CIBMTR ) GVHD organ stage‐derived grading systems. As neither GVHD grading system optimally predicted outcomes, a novel acute GVHD risk score was devised by combining the MN and CIBMTR systems. Using multiple regression analysis, we could dichotomize patients into high risk ( HR , n = 86) acute GVHD with initial grade IIIC , IIID or IVD who were less likely to respond to steroid therapy by day 28 [relative risk ( RR ), 0·3, P < 0·001] and had a higher risk for transplant‐related mortality ( RR , 2·0, P < 0·001) than patients with standard risk ( SR , initial grade IA – IIIB , n = 778) GVHD . Using this novel acute GVHD Risk Score, HR GVHD is either skin stage 4, lower gastrointestinal ( GI ) stage 3+, liver stage 3+, or skin stage 3 and lower GI or liver stage 2+ GVHD . Patients with HR acute GVHD have a poor prognosis, require alternative initial therapy and should be the focus of novel therapeutic trials.