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Minnesota GvHD Risk Score
Table 3. Factors associated with day 28 CR/PR, mortality and TRM: multiple regression analyses.
Factors N
Age
<18* 65 18-35** 50 36-59 151 60+ 89
HCT-CI
0* 172 1-2 88 3+ 95
Donor Type
Sibling* 103 Matched URD 49 Mismatched URD 8 Single UCB 54 Double UCB 141
Weeks from HCT to Initial Steroid Rx
Continuous (/week) GVHD Risk†
Standard Risk* 276
Odds Ratio of Day 28 CR/PR (95% CI)
1.0
2.2 (0.8-6.0) 1.2 (0.5-2.5) 1.1 (0.5-2.5)
1.0
1.0 (0.5-1.8) 1.2 (0.6-2.1)
1.0
0.3 (0.2-0.7) 1.9 (0.3-10.4) 3.6 (1.4-9.2) 1.9 (1.0-3.5) 1.02 (0.96-1.08)
1.0
P Hazard Ratio of 2 year Mortality
(95% CI)
P Hazard Ratio of 2 P year TRM
(95% CI)
NS NS
1.0 1.0
NS
NS
0.7 (0.4-1.3) 0.8 (0.5-1.3) 1.1 (0.6-2.0)
0.6 (0.3-1.1) 0.09 0.5 (0.3-0.9) 0.02 0.9 (0.5-1.5) 0.59
1.0 1.0
0.9 (0.6-1.4)
0.66 0.9 (0.5-1.5)
<0.01 1.8 (1.1-3.0) 0.48 1.0 (0.4-3.0) 0.01 0.8 (0.4-1.4) 0.04 1.2 (0.8-1.8)
NS 0.71 (0.50-1.01)
0.95 1.0 (0.3-3.4) 0.98 0.41 0.4 (0.2-1.0) 0.04 0.38 1.2 (0.7-1.9) 0.57 0.06 0.92 (0.87-0.97) 0.05
<0.01 1.8 (1.1-2.7) 0.01
Bold indicates statistical significance. *Reference group †Standard Risk: single organ involvement (stage 1-3 skin or stage 1-2 GI) or two organ involvement (stage 1-3 skin plus
High Risk 79
0.5 (0.3-0.9)
1.7 (1.2-2.4)
<0.01 1.5 (1.0-2.3)
0.02 2.0 (1.1-3.5) 0.02
1.7 (1.2-2.5)
1.0 1.0
1.0 1.0
stage 1 GI; or stage 1-3 skin plus stage 1-4 liver). All other patients are High Risk.
the University of Minnesota using a combined Minnesota- CIBMTR grading system devised by combining the initial GvHD grade as determined by the Minnesota and the CIBMTR grade.14 Patients with this HR GvHD were less likely to respond to steroid therapy and had a twofold increased risk of TRM compared to patients with SR GvHD. Thirty-three percent of the HR group in the Minnesota GvHD scoring system and 79% of the HR in the CIBMTR system were reclassified as being SR.14
We tested this reported GvHD Risk Score, in a larger, multicenter and heterogeneous group of 1723 patients who received steroids as initial systemic therapy for acute GvHD.1 However, recognizing the variability in GvHD
grading across sites, we then examined the details of ini- tial GvHD organ stage combinations to determine whether stage groupings would better identify the patients at the highest risk than GvHD grading. We divid- ed the 1723 patients into 67 categories by organ stage and, thus by the extent of GvHD involvement at onset. We col- lapsed these categories into 17 larger categories clustered as clinically similar cohorts with comparable CR+PR at day 28 and evaluated these new GvHD staging categories for CR+PR, survival, and TRM. We found a clear demar- cation between categories according to the CR+ PR rate at day 28 which also predicted the risks of 6-month mortali- ty and TRM. This allowed the division of the entire cohort
P<0.01
Figure 3. Cumulative incidence of TRM at 6 months after onset of steroid therapy by response to steroids at day 28.
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