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Data-driven grading of acute graft-versus-host disease

Author

Listed:
  • Evren Bayraktar

    (University Hospital Essen
    University Hospital Essen
    TU Dortmund University of Applied Sciences)

  • Theresa Graf

    (University Hospital Essen
    University Hospital Essen)

  • Francis A. Ayuk

    (University Medical Center Hamburg-Eppendorf (UKE))

  • Gernot Beutel

    (Hannover Medical School)

  • Olaf Penack

    (Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin)

  • Thomas Luft

    (University Hospital Heidelberg)

  • Nicole Brueder

    (Hannover Medical School)

  • Gastone Castellani

    (University of Bologna)

  • H. Christian Reinhardt

    (University Hospital Essen
    Partner sites Essen/Düsseldorf
    Partner site Essen)

  • Nicolaus Kröger

    (University Medical Center Hamburg-Eppendorf (UKE))

  • Dietrich W. Beelen

    (University Hospital Essen
    Partner sites Essen/Düsseldorf)

  • Amin T. Turki

    (University Hospital Essen
    University Hospital Essen
    Partner sites Essen/Düsseldorf
    Partner site Essen)

Abstract

Despite advances in allogeneic hematopoietic cell transplantation, acute graft-versus-host disease (aGVHD) remains its leading complication, yet with heterogeneous outcomes. Here, we analyzed aGVHD phenotypes and clinical classifications in depth in large, multicenter cohorts involving 3019 patients and addressed prevailing gaps by developing data-driven models. We compared, tested and verified these along with all conventional classifications in independent cohorts and found that data-driven grading outperformed conventional grading in Akaike information criterion and concordance index metrics. Data-driven classifications refined aGVHD assessment with up to 12 severity grades, which were associated with distinct nonrelapse mortality (NRM) and confirmed the key role of intestinal aGVHD. We developed an online calculator for physicians to implement principal component-derived grading (PC1). These results provide substantial insight into the evaluation of aGVHD phenotypes and multiorgan involvement, which relegates the exclusive reporting of overall aGVHD severity grades in transplant registries and clinical trials. Data-driven aGVHD grading provides an expandable platform to refine classification and transplant risk assessment.

Suggested Citation

  • Evren Bayraktar & Theresa Graf & Francis A. Ayuk & Gernot Beutel & Olaf Penack & Thomas Luft & Nicole Brueder & Gastone Castellani & H. Christian Reinhardt & Nicolaus Kröger & Dietrich W. Beelen & Ami, 2023. "Data-driven grading of acute graft-versus-host disease," Nature Communications, Nature, vol. 14(1), pages 1-17, December.
    • Handle: RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-43372-2
    DOI: 10.1038/s41467-023-43372-2
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