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

Abstract

Summary:Acute graft-versus-host disease (AGVHD) severity is usually graded (grades 0-IV) by the pattern of organ involvement using the classic Glucksberg-Seattle criteria (GSC). Recently, the International Bone Marrow Transplant Registry (IBMTR) developed a new Severity Index by regrouping the patterns of organ involvement into five Indexes (0-D) that appeared more predictive of transplant-related mortality (TRM) and transplant failure (TF, relapse or TRM). We studied the predictive value of both grading systems of TRM, TF and GVHDrelated mortality (GTRM) in a series of 114 consecutive patients у12 years old allografted from a histocompatible sibling at our institution, 100 of whom were evaluable for AGVHD. The IBMTR Severity Index showed better incremental prediction of TRM (relative risks (RR) of 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 were 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 and 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 advanced Indexes (C-D). Keywords: stem cell transplantation; graft-versus-host disease; grading Moderate-to-severe acute GVHD (AGVHD) develops in 20-50% of adult recipients of an HLA-identical sibling allogeneic stem cell transplant (SCT). Mortality directly attributable to AGVHD or its treatment occurs in 10-20% of patients. 1-3 For classification and prognostic information, AGVHD has been graded according to the classic Glucksberg-Seattle criteria (GSC) for more than 20 years. 4,5 Recently, the International Bone Marrow Transplant Registry (IBMTR) designed a new staging system from a large data set of adult patients receiving an HLAidentical sibling BMT. 6 This IBMTR Severity Index appeared more predictive of the risk of transplant-related mortality (TRM) and treatment failure (TF) than the GSC. We report the results of a comparative analysis of these two staging systems in patients allografted at our institution from an HLA-identical sibling over an 8-year period. Materials and methods PatientsFrom January 1990 to March 1998, 114 consecutive patients aged у12 years received an allogeneic SCT at our institution. Patient characteristics are shown in Table 1. The median age was 36 years (range 12-58), and 68% of patients were male. GVHD prophylaxis consisted of CYA plus short-course MTX in 79%, CYA plus prednisone in 11% and CYA alone in 10%. CYA was given at 3 mg/kg/day i.v. started on day Ϫ1, which was later switched to the oral route with the aim of maintaining a trough whole blood concentration of 200-300 ng/mL. Short-course MTX consisted of 15 mg/m 2 on day ϩ1 and 10 mg/m 2 on days ϩ3, ϩ6 and ϩ11. The source of the stem cells was BM ...

Outcomes after Unrelated Umbilical Cord Blood Transplantation for Children with Osteopetrosis

“…Acute GvHD was defined and graded according to international criteria 6 . Chronic GvHD was evaluated considering only patients surviving more than 100 days after transplantation with sustained donor engraftment, using previously published criteria 7 .…”

Rapid response to alefacept given to patients with steroid resistant or steroid dependent acute graft-versus-host disease: a preliminary report

“…GVHD grading was according to the International Bone Marrow Transplant Registry (IBMTR) severity index. 5 …”

G-CSF-treated granulocytes inhibit acute graft-versus-host disease

“…Unfortunately, this treatment is associated with serious adverse effects, of which acute graft-versus-host disease (aGVHD) is the most important. In most studies, [1][2][3][4][5] the incidence of grade II-IV aGVHD in recipients of HLA-matched, related transplantation ranges from 30% to 40%, and the mortality rate can reach 30%.…”