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.

Figure 1

Overall survival by cGVHD risk score. Shown is the probability of overall survival by cGVHD risk score. P < .01 for all comparisons of overall survival (RG1 vs RG2 vs RG3 vs RG4 vs RG5 vs RG6).

Figure 2

NRM by cGVHD risk score. Shown is the cumulative incidence of NRM by cGVHD risk score. P < .01 for the following comparisons for NRM: RG1 vs RG2 vs RG3 vs RG4 vs RG5 (P for RG5 vs RG6 was not significant at .2984).