Independent Validation of Chronic Graft-Versus-Host Disease (GVHD) Grading System Proposed by the NIH Consensus Criteria in Terms of Prognostic Stratification of the Patients Developed Chronic Gvhd
Notice bibliographique
Résumé
Abstract Abstract 1946 Background: A new grading system for graft-versus-host disease (GVHD) severity was established by the National Institute of Health (NIH)-consensus criteria (NCC) which was introduced since 2007. However, prognostic implications of the NCC grading system on GVHD-specific survival (GSS) are still on debate. Methods: A total of 425 consecutive patients who survived beyond 100 days following allogeneic hematopoietic stem cell transplantation (HSCT) at the Princess Margaret Hospital from Jan 1996 to Oct 2007 were reviewed retrospectively and reclassified using the NCC. The GVHD-specific survival was compared according to the severity at onset or at peak of cGVHD by the NCC. Results: Out of 425 patients, 346 patients (81.4%) were diagnosed to have chronic GVHD (cGVHD) by the Revised Seattle criteria (RSC). Among them, 317 patients were reclassified to have classic cGVHD (n=144, 41.6%) and overlap syndrome (n=173, 50.0%) by the NCC. Twenty nine patients (8.4%) were reclassified as late-onset/recurrent acute GVHD. Out of 317 patients diagnosed to have a classic chronic GVHD and overlap syndrome, the severity scores at the onset of cGVHD were as follows: mild (n=137, 43.2%), moderate (n=134, 42.3%) and severe (n=46, 14.5%), while more moderate and severe cGVHD was noted when severity score was assessed at the peak time of cGVHD as mild (41, 12.9%), moderate (n=176, 55.5%) and severe (n=100, 31.6%). With median follow-up duration of 34 months (range 4–93 months), 5 yrs GSS rate was significantly worse in the group with severe grade of cGVHD at onset and at peak: 50.9±7.8% in severe vs. 89.7±3.2% in moderate vs. 93.5±2.4% in mild (at onset, p<0.001) and 69.1±5.2% in severe vs. 93.2±2.1% in moderate vs. 97.3±2.7% in mild (at peak, p<0.001). No differences in GSS were noted between moderate and mild grades of cGVHD at onset and at peak. Multivariate analysis confirmed severe grade of cGVHD at onset (HR 5.18, 95% CI=1.97–13.6) and at peak (HR 3.79, 95% CI=1.79–8.07) by NCC is associated with poor survival. Conclusion: The present study has successfully validated the grading system of NCC. The NCC could predict long-term outcome in the patients with cGVHD and could potentially be used to develop risk-stratified approaches to treatment based on NCC grading. The group with severe grade cGVHD presented inferior long-term outcomes than those with mild/moderate grade cGVHD. GVHD-specific survival according to chronic GVHD grading system A. GSS according to the Revised Seattle Criteria, B. GSS according to the NIH Global score at onset, C. GSS according to the NIH Global score at peak Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,007 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».