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

The disease-specific survival (DSS) of 151 patients with chronic graft-vers us-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 inclu ded the outcome and 23 variables at the diagnosis of cGVHD and at the prima ry treatment failure (PTF). Eighty-nine patients (58%) failed primary thera py far 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) a nd after PTF (DSS2) was 51% (95% confidence interval[CI] = 39%, 60%) and 38 % (95% CI = 28%, 49%), respectively. According to multivariate analysis, ex tensive skin involvement (ESI) more than 50% of body surface area; hazard r atio (HR) of 7.0 (95% CI = 3.6-13.4), thrombocytopenia (TP)(< 100 000/<mu>L ; 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 Karnofsk y 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%, 6 8%, 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 pati ents with similar outcome. (Blood. 2001;97:1219-1226) (C) 2001 by The Ameri can Society of Hematology.