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Multi-center validation of a prognostic grading in chronic graft versus host disease



Multi-center validation of a prognostic grading in chronic graft versus host disease



Blood 98(11 Part 1): 740a-741a, November 16



We previously reported that the 10-year actuarial cGVHD-specific survival after diagnosis of cGVHD was 51% (95%CI=39%, 60%). Deaths because of the relapse of underlying hematologic malignancies had been censored at the time of relapse. Multivariable analysis showed that extensive (>50% of BSA) skin involvement (ESI), thrombocytopenia (TP)(<100K) and progressive-type onset (PTO) were significantly associated with decreased survival. The predictive value of these baseline factors for cGVHD-specific survival was examined using prognostic models based on either a prognostic factor score (PFS) or absolute number of these risk factors (RF) calculated for each individual. The models identified three groups of patients with distinct survival outcomes (Blood 2001; 97:1219-1226; summarized given). Now, we report independent validation of these prognostic models in 3 cohorts. Data were collected as described previously. The only exception is that the extent of skin involvement in the IBMTR database was re-coded as <50% if it was originally recorded as "mild" and >50% if "moderate to severe". RESULTS: (1) IBMTR data: Both PFS and RF models were able to separate patients into three groups with statistically different (p<0.0001) survival outcomes. (2) FHCRC data: Very few patients in this cohort of 188 patients had ESI without PTO (n=19) or PTO without ESI (n=30). Therefore, this cohort was not informative in attempting to determine whether ESI adds prognostic information to TP and PTO. (3) NEBRASKA data: Three groups with different survival outcomes were demonstrated using the RF model only. The statistical power of validation was modest in this cohort possibly because the high-risk group contained only 3 patients. CONCLUSION: This new clinical grading in cGVHD based on 3 prognostic categories could be useful to improve clinical management, trial design, and communication among centers.

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Accession: 035349006

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