Department of Hematology, Oncology and Transplant, University of Minnesota, 420 Delaware St SE, Minneapolis MN 55455, USA.
Blood. 2011 Jun 16;117(24):6714-20. doi: 10.1182/blood-2010-12-323824. Epub 2011 Apr 14.
Several risk factors are associated with increased mortality in patients with chronic graft-versus-host disease (cGVHD), but there is considerable variability in the reported factors. Therefore, we evaluated patient, transplantation, and cGVHD characteristics to develop a risk score in 5343 patients with cGVHD. Ten variables were identified as being significant in multivariate analysis of overall survival and nonrelapse mortality (NRM): age, prior acute GVHD, time from transplantation to cGVHD, donor type, disease status at transplantation, GVHD prophylaxis, gender mismatch, serum bilirubin, Karnofsky score, and platelet count. These 10 variables were used to build a cGVHD risk score, and 6 risk groups (RGs) were identified. The 5-year NRM was 5% (1%-9%) in RG1, 20% (19%-23%) in RG2, 33% (29%-37%) in RG3, 43% (40%-46%) in RG4, 63% (53%-74%) in RG5, and 72% (59%-85%) in RG6. The 5-year overall survival was highest at 91% (95% confidence interval [CI]:85%-97%) in RG1, followed by 67% (65%-69%) in RG2, 51% (46%-55%) in RG3, 40% (37%-43%) in RG4, 21% (12%-30%) in RG5, and 4% (0%-9%) in RG6 (all P < .01). This analysis demonstrates the usefulness of data from a large registry to develop risk-score categories for major transplantation outcomes. Validation of this cGVHD risk score is needed in a different population to ensure its broad applicability.
几种风险因素与慢性移植物抗宿主病（cGVHD）患者的死亡率增加相关，但报告的因素存在相当大的差异。因此，我们评估了 5343 例 cGVHD 患者的患者、移植和 cGVHD 特征，以制定风险评分。在总生存和非复发死亡率（NRM）的多变量分析中，确定了 10 个变量是显著的：年龄、既往急性移植物抗宿主病、从移植到 cGVHD 的时间、供体类型、移植时的疾病状态、GVHD 预防、性别不匹配、血清胆红素、卡氏评分和血小板计数。这 10 个变量用于构建 cGVHD 风险评分，并确定了 6 个风险组（RG）。RG1 的 5 年 NRM 为 5%（1%-9%），RG2 为 20%（19%-23%），RG3 为 33%（29%-37%），RG4 为 43%（40%-46%），RG5 为 63%（53%-74%），RG6 为 72%（59%-85%）。RG1 的 5 年总生存率最高，为 91%（95%置信区间[CI]：85%-97%），其次是 RG2 的 67%（65%-69%），RG3 的 51%（46%-55%），RG4 的 40%（37%-43%），RG5 的 21%（12%-30%），RG6 的 4%（0%-9%）（均<.01）。这项分析表明，从大型注册中心获取的数据对于制定主要移植结局的风险评分类别是有用的。需要在不同人群中验证这种 cGVHD 风险评分，以确保其广泛适用性。
