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

Akahoshi Y, Spyrou N, Weber D, Aguayo-Hiraldo P, Ayuk F, Chanswangphuwana C, Choe HK, Eder M, Etra AM, Grupp SA, Hexner EO, Hogan WJ, Kitko CL, Kraus S, Al Malki MM, Merli P, Qayed M, Reshef R, Schechter T, Ullrich E, Vasova I, Wölfl M, Zeiser R, Baez J, Beheshti R, Eng G, Gleich S, Katsivelos N, Kowalyk S, Morales G, Young R, Chen YB, Nakamura R, Levine JE, Ferrara JL (2024)

Publication Type: Journal article

Publication year: 2024

Journal

DOI: 10.1182/blood.2024025106

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). We conclude that the MAGIC composite score more accurately predicts response to therapy and long-term outcomes than systems based on clinical symptoms alone and may help guide clinical decisions and trial design.

Authors with CRIS profile

Involved external institutions

Emory University United States (USA) (US) Icahn School of Medicine at Mount Sinai United States (USA) (US) Universität Regensburg Germany (DE) University of Southern California (USC) United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Chulalongkorn University / จุฬาลงกรณ์มหาวิทยาลัย Thailand (TH) Ohio State University United States (USA) (US) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Children's Hospital of Philadelphia United States (USA) (US) Penn Medicine United States (USA) (US) Mayo Clinic United States (USA) (US) Vanderbilt University United States (USA) (US) Universitätsklinikum Würzburg Germany (DE) City of Hope Medical Center United States (USA) (US) Ospedale Pediatrico Bambino Gesu Italy (IT) Columbia University Irving Medical Center (CUIMC) United States (USA) (US) The Hospital for Sick Children (SickKids) Canada (CA) Goethe-Universität Frankfurt am Main Germany (DE) Universitätsklinikum Freiburg Germany (DE) Massachusetts General Hospital United States (USA) (US)

How to cite

APA:

Akahoshi, Y., Spyrou, N., Weber, D., Aguayo-Hiraldo, P., Ayuk, F., Chanswangphuwana, C.,... Ferrara, J.L. (2024). Novel MAGIC composite scores using both clinical symptoms and biomarkers best predict treatment outcomes of acute GVHD. Blood. https://doi.org/10.1182/blood.2024025106

MLA:

Akahoshi, Yu, et al. "Novel MAGIC composite scores using both clinical symptoms and biomarkers best predict treatment outcomes of acute GVHD." Blood (2024).

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