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Annals of Hematology

, Volume 96, Issue 5, pp 805–815 | Cite as

Improved prognostic stratification power of CIBMTR risk score with the addition of absolute lymphocyte and eosinophil counts at the onset of chronic GVHD

  • Joon Ho Moon
  • Nada Hamad
  • Sang Kyun Sohn
  • Jieun Uhm
  • Naheed Alam
  • Vikas Gupta
  • Jeffrey H. Lipton
  • Hans A. Messner
  • Matthew Seftel
  • John Kuruvilla
  • Dennis (Dong Hwan) Kim
Original Article

Abstract

The CIBMTR chronic graft-versus-host disease (cGVHD) risk score can be refined and improved for better prognostic stratification. Three hundred and seven consecutive patients diagnosed with cGVHD by the NIH consensus criteria were retrospectively reviewed and had the CIBMTR risk score applied and analyzed. The CIBMTR risk score was successfully validated in our cohort (n = 307). The 3-year overall survival (OS) rates in each risk group (RG) were 82.5 ± 11.3% (RG1), 79.4 ± 3.0% (RG2), 71.8 ± 6.3% (RG3), and 27.3 ± 13.4% (RG4). A significantly lower OS rate and higher non-relapse mortality (NRM) were noted in RG4 compared to the other RGs. However, there were no differences in OS or NRM among RG1 to 3. To improve prognostic stratification power of the CIBMTR risk score, we incorporated the absolute lymphocyte (ALC) and eosinophil count (EC) at time of cGVHD into the CIBMTR risk score. Lower ALC (<1.0 × 109/L, HR 1.94, p = 0.014) and lower EC (<0.5 × 109/L, HR 3.27, p = 0.014) were confirmed as adverse risk factors for OS. Patients were stratified into four revised risk groups (rRG). The 3-year OS rates were 93.3 ± 6.4% (rRG1, score 0–3), 84.9 ± 3.4% (rRG2, score 4–6), 70.9 ± 4.4% (rRG3, score 7–9), and 32.0 ± 1.1% (rRG4, score ≥ 10) (p < 0.001). The 3-year NRM rates were 0.0% (rRG1), 6.7 ± 0.4% (rRG2), 18.4 ± 0.7% (rRG3), and 57.7 ± 5.1% (rRG4) (p < 0.001). The revised CIBMTR risk score was superior to the original CIBMTR risk score for OS (p < 0.001). The revised CIBMTR risk score including ALC and EC at the onset of cGVHD improved the prognostic stratification power of the CIBMTR risk score for long-term outcomes.

Keywords

Allogeneic stem cell transplantation Graft-versus-host disease CIBMTR risk score Absolute lymphocyte count Eosinophil count 

Notes

Acknowledgements

J.H.M.: provided the acquisition of data, analysis and interpretation of data, drafting the article, revised it critically for important intellectual content; S.K.S.: revised the article critically for important intellectual content; N.H. and J.U.: supplied the acquisition of data, revision of manuscript and approved final version of manuscript; N.A., V.G., J.L., H.M., M.S. and J.K.: revised the article critically for important intellectual content and approved final version of manuscript; D.K.: provided the conception and design of the study, revised the article critically for important intellectual content, approved final version of manuscript and worked as senior author.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Joon Ho Moon
    • 1
  • Nada Hamad
    • 2
  • Sang Kyun Sohn
    • 1
  • Jieun Uhm
    • 2
  • Naheed Alam
    • 2
  • Vikas Gupta
    • 2
  • Jeffrey H. Lipton
    • 2
  • Hans A. Messner
    • 2
  • Matthew Seftel
    • 2
  • John Kuruvilla
    • 2
  • Dennis (Dong Hwan) Kim
    • 2
  1. 1.Department of Hematology/OncologyKyungpook National University HospitalDaeguKorea
  2. 2.Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of MedicineUniversity of TorontoTorontoCanada

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