IBMTR Severity INDEX FOR GRADING ACUTE GRAFT‐VERSUS‐HOST DISEASE: RETROSPECTIVE COMPARISON WITH GLUCKSBERG GRADE

Abstract

Acute graft‐versus‐host disease (GVHD) severity is graded by pattern of organ involvement and clinical performance status using a system introduced by Glucksberg and colleagues 21 years ago. We examined how well Glucksberg grade predicted transplant outcome and constructed a Severity Index not requiring subjective assessment of performance in 2881 adults receiving an HLA‐identical sibling T‐cell‐depleted (n = 752) or non‐T‐cell‐depleted (n = 2129) bone marrow transplant for leukaemia between 1986 and 1992. Relative risks (RR) of relapse, treatment‐related mortality (TRM) and treatment failure (TF) (relapse or death) were calculated for patients with Glucksberg Grade I, II or III/IV acute GVHD versus those without acute GVHD and for patients with distinct patterns of organ involvement regardless of Glucksberg grade. Using data for non‐T‐cell‐depleted transplants, a Severity Index was developed grouping patients with patterns of organ involvement associated with similar risks of TRM and TF. Higher Glucksberg grade predicted poorer outcome; however, patients with the same grade but different patterns of skin, liver or gut involvement often had significantly different outcomes. The revised Severity Index groups patients in four categories, A–D. Compared to patients without acute GVHD, RRs (95% confidence interval) of TF were 0.85 (0.69, 1.05) for patients with Index A, 1.21 (1.02, 1.43) with B, 2.19 (1.78, 2.71) with C, and 5.69 (4.57, 7.08) with D. Prognostic utility of the Index was tested in patients receiving T‐cell‐depleted transplants; similar RRs of TF were observed. An acute GVHD Severity Index is proposed to enhance design and interpretation of clinical trials in the current era of allogeneic blood and bone marrow transplantation.

Outcome of alloanergized haploidentical bone marrow transplantation after ex vivo costimulatory blockade: results of 2 phase 1 studies

“…17,18 Wherever possible, histologic confirmation of clinical diagnoses of aGVHD was sought. Performance status of surviving patients was assessed using Karnofsky or Lansky scoring, appropriate to age.…”

KIR genes and KIR ligands affect occurrence of acute GVHD after unrelated, 12/12 HLA matched, hematopoietic stem cell transplantation

“…Criteria for clinical diagnoses of acute and cGVHD were previously described. 17,18 HLA and KIR genotyping Blood samples for tissue typing were obtained upon written consent from patients and donors, and approved by the ethical committee of the Medical University of Vienna. DNA was isolated either by the salting-out method or by using an automated DNA extraction device (GenoM-6; GenoVision VertriebsgesmbH, Vienna, Austria).…”

Reproducibility in retrospective grading of acute graft-versus-host disease after allogeneic marrow transplantation

“…stages in ways that reproducibly strengthen the association The revised system for grading relies heavily on the between overall grade and risk of transplant-related morclinical judgement and treatment decisions of physicians tality. 8 The rearranged criteria still depend on assessments responsible for the care of patients. To a considerable of the peak severity of abnormalities in the skin, liver and extent, the revised grading system represents a categorizgut which have been shown to lack reproducibility.…”