What Predicts High Risk Acute Gvhd At Diagnosis?: Identification of Those At Highest Risk by a Novel Acute Gvhd Risk Score,

To define high risk acute graft-versus-host disease (GVHD) at its onset, we examined the initial GVHD stage and grade of 864 patients at the University of Minnesota who received uniform therapy with prednisone 60 mg/m²/d. We compared the prognostic utility of the Minnesota (MN) (modified from Consensus) versus Center for International Blood and Marrow Transplant Research (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, IID or IVD who were significantly less likely to respond to steroid therapy by day 28 than patients with standard risk (SR, initial grade IA-IIIB, n=778) GVHD (Univariate complete response [CR]+ partial response [PR] at day 28: HR 43% [95% CI 33–53%] vs. SR 68% [95% CI 65–71%], p <.001; Multivariate HR Relative Risk [RR] of overall response [CR+PR], 0.3, 95% CI, 0.2–0.5, p<.001). The probability of treatment-related mortality (TRM) at 2 years was significantly higher in patients with HR than SR acute GVHD (51% [95% CI 40–62%] vs. 38% [95% CI 35–41%], p <.01) (figure).