Comparison of the classic Glucksberg criteria and the IBMTR Severity Indexfor grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation

Acute graft-versus-host disease (AGVHD) severity is usually graded (grades 0-IV) by the pattern of organ involvement using the classic Glucksberg-Seat tle criteria (GSC). Recently, the International Bone Marrow Transplant Regi stry (IBMTR) developed a new Severity Index by regrouping the patterns of o rgan involvement into five Indexes (0-D) that appeared more predictive of t ransplant-related mortality (TRM) and transplant failure (TF, relapse or TR M). We studied the predictive value of both grading systems of TRM, TF and GVHD-related mortality (GTRM) in a series of 114 consecutive patients great er than or equal to 12 years old allografted from a histocompatible sibling at our institution, 100 of whom were evaluable for AGVHD. The IBMTR Severi ty Index showed better incremental prediction of TRM (relative risks (RR) o f 1, 1.5, 1.4, 2 and 2.5 for Indexes 0, A, B, C and D), TF (RRs of 1, 1.6, 1.6, 2 and 2.3, respectively) and GTRM (RRs of 1, 2.2 and 4.8 for Indexes B , C and D) than the GSC. With the GSC different outcomes for TRM and TF wer e found only from grade 0 to I-II and 0 to IV or I-III to IV, but not from I-II to III. The GSC also appeared less predictive of GTRM (RRs of 1, 0.4 a nd 2.9 for grades II, III and IV). In our relatively small patient sample, the new IBMTR Severity Index appeared more predictive of transplant outcome than the GSC, especially between no AGVHD, early Indexes (A-B) and advance d Indexes (C-D).