https://orcid.org/0000-0002-4801-2532
Key Points
We developed and validated a risk score for acute graft-versus-host disease following allogeneic hematopoietic cell transplantation.
The risk score uses baseline clinical factors readily available to a physician and is available as a risk calculator online at cibmtr.org.
Acute graft-versus-host disease (aGVHD) contributes to significant morbidity following allogeneic hematopoietic cell transplantation (alloHCT). We aimed to develop and validate a clinical score to identify patients with significantly different risk for developing aGVHD. Analysis included adults who underwent alloHCT during 2008-2019. Eligibility criteria were widely inclusive of transplant indications, donor types, graft types, conditioning regimens, and GVHD prophylaxis regimens. The final cohort of 21,796 patients was randomly split into training and validation cohorts, with 15,258 (70%) and 6,538 (30%) patients, respectively. The primary outcome was grades II-IV aGVHD, and the secondary outcome grades III-IV aGVHD, by day 100 post-transplant. Risk scores were developed using the training cohort, tested using the validation cohort, and stratified into 4 percentile groups. Odds of aGVHD II-IV by day 100 post-transplant were 1.50 (95% CI, 1.29-1.75; P < .0001) for the 25-50 percentile group, 2.0 (95% CI, 1.78-2.40; P < .0001) for the 50-75 percentile group, and 3.1 (95% CI, 2.72-3.65; P < .0001) for the > 75 percentile group compared to the ≤ 25 percentile group in the validation cohort. Odds of aGVHD III-IV by day 100 post-transplant were 1.4 (95% CI; 1.11-1.74, P = .0043) in the 25 to 50 percentile group, 2.0 (95% CI, 1.61-2.49, P < .0001) in the 50 to 75 percentile group, and 3.2 (95% CI, 2.64-3.98, P < .0001) in the > 75 percentile group compared to the ≤ 25 percentile group in the validation cohort. Here we have developed the first validated, widely inclusive clinical risk score for the development of aGVHD following alloHCT.
