Prognostic Factors of Chronic Graft-versus-Host Disease Following Allogeneic Peripheral Blood Stem Cell Transplantation: The National Institutes Health Scale Plus the Type of Onset Can Predict Survival Rates and the Duration of Immunosuppressive Therapy

Abstract

Several grading systems have been developed in the bone marrow transplantation setting in attempts to predict survival in patients with chronic graft-versus-host disease (cGVHD). In this study, we evaluated the prognostic value of the National Institutes of Health (NIH) scoring system and investigated for any additional prognostic factors in a series of 171 patients undergoing peripheral blood stem cell transplantation (PBSCT) from matched related donors. The cumulative incidence of cGVHD was 70%; cumulative incidences of mild, moderate, and severe cGVHD were 29%, 42% and 28%, respectively. Overall, 68% of patients were free from immunosuppression 5 years after transplantation. Absence of previous acute GVHD (aGVHD; hazard ratio [HR] = 2; P = .004) and mild cGVHD (HR = 4.2; P = .007) increased the probability of being off immunosuppressive treatment by the last follow-up. Overall survival (OS) at 5 years was 52%. Severe cGVHD, according to the NIH scoring system (HR = 13.27; P = .001) adversely influenced outcome, whereas de novo onset (HR = 0.094; P = .003) had a more favorable impact on survival. The combination of both variables allowed us to identify 4 different subgroups of patients with OS of 82%, 70%, 50%, and 25%. Our findings indicate that the NIH scoring system has some prognostic value in patients undergoing PBSCT and, together with the type of onset, must be considered to predict the possible outcome of patients who develop cGVHD.

The global severity of chronic graft-versus-host disease, determined by National Institutes of Health consensus criteria, is associated with overall survival and non-relapse mortality

“…10 and Perez-Simon et al reported significant associations of global GVHD severity with GVHD-related mortality and 5-year overall survival. 11 Our analyses further demonstrate the increased risk for mortality in patients with moderate to severe gastrointestinal, hepatic, and pulmonary chronic GVHD manifestations.…”

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

“…[10][11][12][13] We extended these findings by taking the dynamic changes in chronic GVHD severity into account, which mirrors the clinical reality of episodic improvement and worsening over time. Hazard analysis confirmed that the NIH global score correlated well with mortality rates regardless of time since initial treatment, suggesting that the NIH global score is applicable to patients throughout the course of the disease after initial treatment.…”

“…9 Although the NIH global score was developed through expert opinion, several studies have shown that the global score at onset of chronic GVHD is associated with risk of subsequent mortality. [10][11][12][13] Many issues do, however, remain to be determined. (i) Since the NIH global score was based on expert opinion and was not originally intended to predict mortality, does this score provide an optimal model for predicting mortality risk in patients with chronic GVHD?…”

Human chorionic gonadotropin and indolamine 2,3-dioxygenase in patients with GVHD

“…1,2 It is a systemic inflammatory disorder that reflects the lack of immune tolerance between donor-derived immunocompetent cells and host organs. Human chorionic gonadotropin (hCG) hormone is a naturally occurring hormone during pregnancy secreted by syncytiotrophoblasts of the placenta.…”