Graft-versus-Host Disease–Free Relapse-Free Survival Definition for Patients with Nonmalignant Hematologic Disorders
Bibliographic record
Abstract
•The inclusion of grade II acute GVHD and any grade of chronic GVHD in the definition of GRFS could be considered in nonmalignant diseases. We read with interest the study by Vaht et al.1Vaht K. Göransson M. Carlson K. et al.High graft-versus-host disease-free, relapse/rejection-free survival and similar outcome of related and unrelated allogeneic stem cell transplantation for aplastic anemia: a nationwide Swedish cohort study.Biol Blood Marrow Transplant. 2019; 25: 1970-1974Abstract Full Text Full Text PDF Scopus (8) Google Scholar on severe aplastic anemia (SAA) comparing the impact of matched related versus unrelated donors after allogeneic stem cell transplant. The authors report a 5-year graft-versus-host disease (GVHD)-free relapse/rejection-free survival (GRFS) of 69.1% in the entire cohort. GRFS is a composite endpoint focused on survival without relapse and in the absence of clinically relevant GVHD, either grades III to IV acute GVHD or chronic GVHD requiring systemic treatment (defined as moderate to severe by the National Institutes of Health consensus criteria2Jagasia M.H. Greinix H.T. Arora M. et al.National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease. I. The 2014 Diagnosis and Staging Working Group report.Biol Blood Marrow Transplant. 2015; 21: 389-401Abstract Full Text Full Text PDF PubMed Scopus (1390) Google Scholar),3Holtan S.G. DeFor T.E. Lazaryan A. et al.Composite end point of graft-versus-host disease-free, relapse-free survival after allogeneic hematopoietic cell transplantation.Blood. 2015; 125: 1333-1338Crossref PubMed Scopus (333) Google Scholar,4Ruggeri A. Labopin M. Ciceri F. et al.Definition of GvHD-free, relapse-free survival for registry-based studies: an ALWP-EBMT analysis on patients with AML in remission.Bone Marrow Transplant. 2016; 51: 610-611Crossref PubMed Scopus (173) Google Scholar and its utility has been recognized by the Blood and Marrow Transplant Clinical Trials Network. This definition is primarily used for malignant diseases, where there is a benefit from graft-versus leukemia effect in reducing relapse. We agree with the authors that in patients diagnosed with SAA, the term “relapse-free survival” should be modified for graft failure or rejection-free survival.1Vaht K. Göransson M. Carlson K. et al.High graft-versus-host disease-free, relapse/rejection-free survival and similar outcome of related and unrelated allogeneic stem cell transplantation for aplastic anemia: a nationwide Swedish cohort study.Biol Blood Marrow Transplant. 2019; 25: 1970-1974Abstract Full Text Full Text PDF Scopus (8) Google Scholar However, we suggest that grade II acute GVHD and any chronic GVHD should be included in the definition of GRFS. The morbidity/mortality associated with grade II acute GVHD is not insignificant, and the impairment of quality of life secondary to mild chronic GVHD is undesirable in nonmalignant disorders where there is no benefit from a graft-versus leukemia effect. Hence, broadening the definition of GRFS in allogeneic stem cell transplant for nonmalignant disorders like SAA is recommended. Financial disclosure: The authors have nothing to disclose. Conflict of interest statement: There are no conflicts of interest to report.
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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 | 0.006 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
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".