Prognostic Score for Patient with Chronic Graft-versus-Host Disease After Bone Marrow Transplantation

 

Patient selection: GVHD after bone marrow transplantation (BMT)

 

Outcome:mortality

 

Parameters:

(1) presentation

(2) serum total bilirubin in mg/dL

(3) histology of skin biopsy

 

Presentation descriptions:

(1) de novo (without preceding GVHD)

(2) quiescent (chronic GVHD after remission from acute GVHD)

(3) progressive (chronic GVHD from acute GVHD without remission)

 

Parameter	Finding	Points
presentation	de novo	0
	quiescent	0
	progressive	1.400
serum total bilirubin	<= 1.2 mg/dL	0
	> 1.2 mg/dL	0.758
skin biopsy	lichenoid	0.776
	other (scleradermatous, etc)	0

 

where:

• The points for each parameter are the coefficients from multivariate analysis.

 

score =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 2.934

• The higher the score the worse the prognosis.

 

Score	6 Year Survival (1989)
0	70%
0.758 to 1.5	44%
> 1.5	20%

 

where:

• Depending on whether rounding is used or not, the combination of elevated bilirubin and lichoid histology (1.534) would be in intermediate vs high risk group. The high risk group would be progressive course plus one or both of the other risk factors.