Leisenring et al developed an activity index for acute graft-versus-host disease (GVHD) in patients undergoing hematopoietic cell transplantation after myeloablative conditioning. This can help identify a patient who may benefit from more aggressive management. The authors are from the Fred Hutchinson Cancer Research Center and University of Washington in Seattle.
Parameters:
(1) serum total bilirubin
(2) upper gut
(3) immunosuppressive therapy
(4) performance (using a modified ECOG performance scale)
|
Parameter |
Finding |
Points |
|
serum total bilirubin |
< 2 mg/dL |
0 |
|
|
2 - 4.99 mg/dL |
16 |
|
|
>= 5.0 |
26 |
|
upper gut |
oral intake >= 40% of requirements |
0 |
|
|
oral intake < 40% of requirements with poorly controlled anorexia, nausea and vomiting |
20 |
|
immunosuppressive therapy |
none |
0 |
|
|
any prednisone dose OR secondary therapy for GVHD |
17 |
|
performance |
modified ECOG 0 |
0 |
|
|
modified ECOG 1 or 2 |
20 |
|
|
modified ECOG 3 or 4 |
37 |
where:
• Table 2 has serum bilirubin from 2-4 and >= 5 mg/dL, with 4.01 to 4.99 uncommitted.
• The upper gut parameter consists of decreased oral intake AND poorly controlled symptoms. It appears that only having one of these would be graded as 0.
total activity index =
= SUM(points for all 4 parameters)
Interpretation:
• minimum activity index: 0
• maximum activity index: 100
• The higher the index the more severe the GVHD.
• The probability of nonrelapse mortality at 200 days can be estimated using the graphs in Figure 4 (page 754) for the activity index determined on days 0-19, 20-39 and 40-100.
|
Activity Index |
0-19 Days |
20-39 Days |
40-100 Days |
|
20 |
16% |
3% |
8% |
|
30 |
22% |
7% |
11% |
|
35 |
|
14% |
|
|
40 |
26% |
22% |
19% |
|
45 |
26% |
24% |
23% |
|
50 |
25% |
24% |
29% |
|
55 |
24% |
24% |
|
|
60 |
24% |
28% |
47% |
|
65 |
25% |
|
|
|
70 |
27% |
38% |
69% |
|
80 |
33% |
52% |
83% |
|
90 |
42% |
64% |
89% |
|
100 |
54% |
75% |
94% |
probability for index during days 0 to 19 over range 20 to 45 =
= (-0.000148 * ((index)^2)) + (0.01371 * (index)) - 0.05593
probability for index during days 0 to 19 over range 65 to 100 =
= (0.000148 * ((index)^2)) - (0.01612 * (index)) + 0.6734
probability for index during days 20 to 39 over range 20 to 40 =
= (0.000518 * ((index)^2)) - (0.02146 * (index)) + 0.2514
probability for index during days 20 to 39 over range 55 to 100 =
= (0.000025 * ((index)^2)) + (0.007737 * (index)) - 0.2706
probability for index during days 40 to 100 over range 20 to 45 =
= (0.000178 * ((index)^2)) - (0.00543 * (index)) + 0.1161
probability for index during days 40 to 100 over range 45 to 70 =
= (0.000257 * ((index)^2)) - (0.01106 * (index)) + 0.2041
probability for index during days 40 to 100 over range 7o to 100 =
= (-0.000300 * ((index)^2)) + (0.0594 * (index)) - 2.008
Purpose: To determine the activity of acute graft vs host disease (GVHD) using the index of Leisenring et al.
Specialty: Immunology/Rheumatology
Objective: laboratory tests, disease progression, complication detection
ICD-10: T86,
