ACUTE GRAFT-VERSUS-HOST DISEASE - GRADE AND OUTCOME IN PATIENTS WITH CHRONIC MYELOGENOUS LEUKEMIA

Acute graft-versus-host disease (aGVHD) has been classified according to the Seattle criteria as grades 0, I, II, III, and IV for 20 years. The predictive value of such detailed grading is a matter of debate; p ublications usually report GVHD as present or absent or as absent, mod erate, or severe. The Working Party Chronic Leukemia of the European G roup for Bone Marrow Transplantation analyzed data of 1,294 patients t ransplanted from an allogeneic donor for chronic myelogenous leukemia (CML) in first chronic phase and tested the predictive value of aGVHD grading for the following endpoints: day 100 mortality (D100M), transp lant-related mortality (TRM), relapse incidence (RI), leukemia-free su rvival (LFS), and survival (SURV). aGVHD was absent in 462 patients (3 5.7%), grade I occurred in 335 (25.8%), grade II in 264 (20.5%), grade III in 110 (8.5%), and grade IV in 123 patients (9.5%). A total of 29 7 patients (23%) died within 100 days, 495 patients (38%) died of any TRM, and 100 patients (8%) died of relapse. D100M according to grades 0, I, II, III, and IV was 17%, 13%, 19%, 38%, and 70%, respectively, w ith significant difference between 0-II versus III-IV. TRM was 28%, 27 %, 43%, 68%, and 92%, respectively, with a distinct separation between 0-I versus II-IV. RI showed a continuous decrease of 37%, 30%, 23%, 1 8%, and 8%, respectively, with increasing aGVHD. LFS was 45%, 51%, 44% , 26%, and 7%, respectively, and was best for patients with grade I aG VHD. This finding was also reflected in a better overall survival (60% , 64%, 53%, 30%, and 8%, respectively). The better LFS for grade I aGV HD patients compared with patients with grade 0 or II aGVHD was confir med (P = .05) in a multivariate analysis. These data document the valu e of the present 5-point grading of aGVHD, ie, different outcome is ob served depending on endpoint analyzed. Restricting information about a GVHD to presence or absence is not warranted. (C) 1995 by The American Society of Hematology.