Association of severity of organ involvement with mortality and recurrent malignancy in patients with chronic graft-versus-host disease.

Publication Type:

Journal Article

Source:

Haematologica, Volume 99, Issue 10, p.1618-23 (2014)

Keywords:

2014, Center-Authored Paper, Clinical Research Division, July 2014, Research Trials Office Core Facility - Biostatistics Service

Abstract:

The National Institutes of Health global score for chronic graft-versus-host disease was devised by experts but was not based on empirical data. We hypothesized that analysis of prospectively collected data would allow derivation of a more accurate model for estimating mortality risk. We analyzed 574 adult patients with chronic graft-versus-host disease enrolled in a multicenter, observational study, using multivariate time-varying analysis accounting for serial changes in severity of eight individual organ sites over time. In the training set, severity of skin, mouth, gastrointestinal tract, liver and lung involvement were independently associated with the risk of nonrelapse mortality. Weighted mortality points were assigned to individual organs based on the hazard ratios and were summed. The population was divided into three risk groups based on the total mortality points. The three new risk groups were validated in an independent validation set, but did not show better discriminative performance than the National Institutes of Health global score. As compared to moderate or mild global score, severe global score was associated with increased risks of nonrelapse and overall mortality across time but not with a decreased risk of recurrent malignancy. The National Institutes of Health global score predicts mortality risk throughout the course of patients with chronic graft-versus-host disease. Further research is required in order to improve outcomes in patients with severe chronic graft-versus-host disease, since their risk of mortality remains elevated.