Novel MAGIC composite scores using both clinical symptoms and biomarkers best predict treatment outcomes of acute GVHD

作者：Yu Akahoshi, Nikolaos Spyrou, Daniela Weber, Paibel Ixia Aguayo-Hiraldo, Francis Ayuketang Ayuk, Chantiya Chanswangphuwana, Hannah Kyung Choe, Matthias Eder, Aaron M. Etra, Stephan A. Grupp, Elizabeth Olson Hexner, William J. Hogan, Carrie Lynn Kitko, Sabrina Kraus, Monzr M. Al Malki, Pietro Merli, Muna Qayed, Ran Reshef, Tal Schechter, Evelyn Ullrich, Ingrid Vášová, Matthias Wölfl, Robert Zeiser, Janna Baez, Rahnuma Beheshti, Gilbert Eng, Sigrun Gleich, Nikolaos Katsivelos, Steven Kowalyk, George Morales, Rachel A Young, Yi‐Bin Chen, Ryotaro Nakamura, John E. Levine, James L.M. Ferrara · 发表于：Blood · 年份：2024 · DOI：10.1182/blood.2024025106 · 被引用次数：34 · 研究领域：Cardiac pacing and defibrillation studies、Cardiovascular Syncope and Autonomic Disorders、Heart Failure Treatment and Management

ABSTRACT: Acute graft-versus-host disease (GVHD) grading systems that use only clinical symptoms at treatment initiation such as the Minnesota risk identify standard and high-risk categories but lack a low-risk category suitable to minimize immunosuppressive strategies. We developed a new grading system that includes a low-risk stratum based on clinical symptoms alone and determined whether the incorporation of biomarkers would improve the model's prognostic accuracy. We randomly divided 1863 patients in the Mount Sinai Acute GVHD International Consortium (MAGIC) who were treated for GVHD into training and validation cohorts. Patients in the training cohort were divided into 14 groups based on similarity of clinical symptoms and similar nonrelapse mortality (NRM); we used a classification and regression tree (CART) algorithm to create three Manhattan risk groups that produced a significantly higher area under the receiver operating characteristic curve (AUC) for 6-month NRM than the Minnesota risk classification (0.69 vs 0.64, P = .009) in the validation cohort. We integrated serum GVHD biomarker scores with Manhattan risk using patients with available serum samples and again used a CART algorithm to establish 3 MAGIC composite scores that significantly improved prediction of NRM compared to Manhattan risk (AUC, 0.76 vs 0.70, P = .010). Each increase in MAGIC composite score also corresponded to a significant decrease in day 28 treatment response (80% vs 63% vs 30%, P < .001)...