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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".