Hepatic grading systems for categorizing severity in chronic graft versus host disease (cGvHD) were determined arbitrarily, leading us to initiate the present study to provide objective evidence for the determination of optimal cut-off values and devise a hepatic grading system to predict prognosis.
Of 842 patients who received allogeneic hematopoietic stem transplant (HCT), 336 patients diagnosed with cGvHD were evaluated for overall survival (OS) and non-relapse mortality (NRM) after cGVHD development. Multiple statistical parameters were evaluated to define optimal cut-off values of liver profile, including negative- (NPV), positive-predictive value (PPV), accuracy, and p-values as measures of risk stratification power.
We found that alkaline phosphatase (ALP) ≥ 146 IU/L (NPV 83.4%, PPV 32.8%, accuracy 52.7%) and bilirubin ≥ 14 µmol/L (NPV 81.8%, PPV 39.4%, accuracy 68.1%) significantly correlated with OS. We developed a refined hepatic-cGvHD grading score (RHS), stratifying patients into a low RHS group with RHS score 0 OS at 3y (n=162) to 80.5%, compared to high RHS group with score 1-2 (n=172) 62.7%. Regarding NRM, score 0 segregated NRM at 3y to 11.9%, compared to score 1-2 19.6% p=0.09.
RHS is promising for stratifying patients with cGVHD and liver involvement according to long-term outcomes.