Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Divisione di Ematologia, Ospedale di Bolzano, Italy.
Blood Adv. 2022 Apr 12;6(7):2309-2318. doi: 10.1182/bloodadvances.2021005675.
The aim of this study was to develop a predictive score for moderate-severe chronic graft-versus-host disease (cGVHD) on day +100 after allogeneic stem cell transplantation (HSCT). We studied 1292 patients allografted between 1990 and 2016, alive on day +100 after transplant, without cGVHD, and with full biochemistry laboratory values available. Patients were randomly assigned to a training and a validation cohort (ratio 1:1). In the training cohort, a multivariate analysis identified 4 independent predictors of moderate-severe cGVHD: gamma-glutamyl transferase ≥75 UI/l, creatinine ≥1 mg/dl, cholinesterase ≤4576 UI/l, and albumin ≤4 g/dl. A score of 1 was assigned to each variable, producing a low (0 to 1), intermediate (2 to 3), and high (4) score. The cumulative incidence of moderate-severe cGVHD was 12%, 20%, and 52% (P < .0001) in the training cohort, and 13%, 24%, and 33% (P = .002) in the validation cohort, respectively. The 5-year cumulative incidence of transplant-related mortality (TRM) was 5%, 14%, 27% (P < .0001) and 5%, 16%, 31% (P < .0001), respectively. The 5-year survival was 64%, 57%, 54% (P = .009) and 70%, 59%, 42% (P = .0008) in the 2 cohorts, respectively. In conclusion, Day100 score predicts cGVHD, TRM, and survival and, if validated in a separate group of patients, could be considered for trials of preemptive therapy.
本研究旨在开发一种预测异基因干细胞移植（HSCT）后 100 天发生中重度慢性移植物抗宿主病（cGVHD）的评分系统。我们研究了 1990 年至 2016 年期间接受同种异体移植、移植后 100 天存活、无 cGVHD 且可获得完整生化实验室值的 1292 例患者。患者被随机分配到训练队列和验证队列（比例为 1:1）。在训练队列中，多变量分析确定了中重度 cGVHD 的 4 个独立预测因素：谷氨酰转肽酶（γ-GT）≥75UI/L、肌酐≥1mg/dl、胆碱酯酶≤4576UI/L 和白蛋白≤4g/dl。每个变量赋值 1 分，产生低（0-1）、中（2-3）和高（4）评分。在训练队列中，中重度 cGVHD 的累积发生率分别为 12%、20%和 52%（P<0.0001），在验证队列中分别为 13%、24%和 33%（P=0.002）。移植相关死亡率（TRM）的 5 年累积发生率分别为 5%、14%、27%（P<0.0001）和 5%、16%、31%（P<0.0001）。在这两个队列中，5 年生存率分别为 64%、57%、54%（P=0.009）和 70%、59%、42%（P=0.0008）。总之，第 100 天评分可预测 cGVHD、TRM 和生存率，如果在另一组患者中得到验证，可考虑用于预防性治疗的试验。
