Development of a prognostic model for grading chronic graft-versus-host disease

Görgün Akpek, Marianna L. Zahurak, Steven Piantadosi, Jeffrey Margolis, Jon Doherty, Robert Davidson, Georgia Boyce Vogelsang

Research output: Contribution to journalArticle

Abstract

The disease-specific survival (DSS) of 151 patients with chronic graft-versus-host disease (cGVHD) was studied in an attempt to stratify patients into risk groups and to form a basis for a new grading of cGVHD. The data included the outcome and 23 variables at the diagnosis of cGVHD and at the primary treatment failure (PTF). Eighty-nine patients (58%) failed primary therapy for cGVHD. Nonrelapse mortality was 44% after a median follow-up of 7.8 years. The probability of DSS at 10 years after diagnosis of cGVHD (DSS1) and after PTF (DSS2) was 51% (95% confidence interval [CI] = 39%, 60%) and 38% (95% CI = 28%, 49%), respectively. According to multivariate analysis, extensive skin involvement (ESI) more than 50% of body surface area; hazard ratio (HR) of 7.0 (95% CI = 3.6-13.4), thrombocytopenia (TP) (<100 000/μL; HR, 3.6; 95% CI = 1.9-6.8), and progressive-type onset (PTO) (HR, 1.7; 95% CI = 0.9-3.0) significantly influenced DSS1. These 3 factors and Karnofsky Performance Score of less than 50% at PTF were significant predictors for DSS2. The DSS1 at 10 years for patients with prognostic factor score (PFS) at diagnosis of 0 (none), less than 2 (ESI only or TP and/or PTO), 2 to 3.5 (ESI plus either TP or PTO), and more than 3.5 (all 3 factors) was 82%, 68%, 34%, and 3% (P= .05, <.001, <.001), respectively. The DSS2 at 5 years for patients with PFS at PTF of 0, 2 or less, 2 to 3.5, and more than 3.5 were 91%, 71%, 22%, and 4% (P= .2, .005, and <.001), respectively. It was concluded that these prognostic models might be useful in grouping the patients with similar outcome.

Original languageEnglish (US)
Pages (from-to)1219-1226
Number of pages8
JournalBlood
Volume97
Issue number5
DOIs
StatePublished - Mar 1 2001

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Graft vs Host Disease
Grafts
Treatment Failure
Confidence Intervals
Thrombocytopenia
Hazards
Skin
Survival
Body Surface Area
Multivariate Analysis
Mortality

ASJC Scopus subject areas

  • Hematology

Cite this

Akpek, G., Zahurak, M. L., Piantadosi, S., Margolis, J., Doherty, J., Davidson, R., & Vogelsang, G. B. (2001). Development of a prognostic model for grading chronic graft-versus-host disease. Blood, 97(5), 1219-1226. https://doi.org/10.1182/blood.V97.5.1219

Development of a prognostic model for grading chronic graft-versus-host disease. / Akpek, Görgün; Zahurak, Marianna L.; Piantadosi, Steven; Margolis, Jeffrey; Doherty, Jon; Davidson, Robert; Vogelsang, Georgia Boyce.

In: Blood, Vol. 97, No. 5, 01.03.2001, p. 1219-1226.

Research output: Contribution to journalArticle

Akpek, G, Zahurak, ML, Piantadosi, S, Margolis, J, Doherty, J, Davidson, R & Vogelsang, GB 2001, 'Development of a prognostic model for grading chronic graft-versus-host disease', Blood, vol. 97, no. 5, pp. 1219-1226. https://doi.org/10.1182/blood.V97.5.1219
Akpek G, Zahurak ML, Piantadosi S, Margolis J, Doherty J, Davidson R et al. Development of a prognostic model for grading chronic graft-versus-host disease. Blood. 2001 Mar 1;97(5):1219-1226. https://doi.org/10.1182/blood.V97.5.1219
Akpek, Görgün ; Zahurak, Marianna L. ; Piantadosi, Steven ; Margolis, Jeffrey ; Doherty, Jon ; Davidson, Robert ; Vogelsang, Georgia Boyce. / Development of a prognostic model for grading chronic graft-versus-host disease. In: Blood. 2001 ; Vol. 97, No. 5. pp. 1219-1226.
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abstract = "The disease-specific survival (DSS) of 151 patients with chronic graft-versus-host disease (cGVHD) was studied in an attempt to stratify patients into risk groups and to form a basis for a new grading of cGVHD. The data included the outcome and 23 variables at the diagnosis of cGVHD and at the primary treatment failure (PTF). Eighty-nine patients (58{\%}) failed primary therapy for cGVHD. Nonrelapse mortality was 44{\%} after a median follow-up of 7.8 years. The probability of DSS at 10 years after diagnosis of cGVHD (DSS1) and after PTF (DSS2) was 51{\%} (95{\%} confidence interval [CI] = 39{\%}, 60{\%}) and 38{\%} (95{\%} CI = 28{\%}, 49{\%}), respectively. According to multivariate analysis, extensive skin involvement (ESI) more than 50{\%} of body surface area; hazard ratio (HR) of 7.0 (95{\%} CI = 3.6-13.4), thrombocytopenia (TP) (<100 000/μL; HR, 3.6; 95{\%} CI = 1.9-6.8), and progressive-type onset (PTO) (HR, 1.7; 95{\%} CI = 0.9-3.0) significantly influenced DSS1. These 3 factors and Karnofsky Performance Score of less than 50{\%} at PTF were significant predictors for DSS2. The DSS1 at 10 years for patients with prognostic factor score (PFS) at diagnosis of 0 (none), less than 2 (ESI only or TP and/or PTO), 2 to 3.5 (ESI plus either TP or PTO), and more than 3.5 (all 3 factors) was 82{\%}, 68{\%}, 34{\%}, and 3{\%} (P= .05, <.001, <.001), respectively. The DSS2 at 5 years for patients with PFS at PTF of 0, 2 or less, 2 to 3.5, and more than 3.5 were 91{\%}, 71{\%}, 22{\%}, and 4{\%} (P= .2, .005, and <.001), respectively. It was concluded that these prognostic models might be useful in grouping the patients with similar outcome.",
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