Ten Year Outcomes of UKALL 2003: A Randomised Clinical Trial of Adjusting Treatment Intensity Based on Minimal Residual Disease

Abstract The UKALL 2003 trial aimed to safely reduce treatment intensity in low-risk patients and intensify therapy in high-risk patients based on minimal residual disease (MRD) stratification. The MRD risk patients were randomly assigned to standard (Regimen A/B) or augmented (Regimen C) post remission therapy, whilst the MRD low risk patients were randomly allocated to receive one or a standard two delayed intensifications (DI). In the original analysis, the five-year event free survival in the MRD risk patients was superior in the augmented group whilst in the MRD low risk group there was no significant difference between one or two delayed intensifications. As late relapses may influence these results, particularly in the low-risk patients, we analysed ten-year outcomes for patients in the trial overall and by the randomisations. There were a total of a total of 3113 eligible patients for analysis. The median follow up time was 9.4 years. In the overall trial population, 10-year relapse risk was 10.7 % (95%CI 9.6-11.92 %), with a 10-year event free survival (EFS) of 84.8 % (95 % CI 83.5-86.1 %) and overall survival (OS) of 89.6% (95%CI 88.4-90.6%). There was a higher risk of relapse on univariate and multivariate cox analysis with male gender, increasing age, increasing white cell count, MRD (high vs low), NCI Risk Group (High vs standard) and immunophenotype (T vs B cell). All except gender were also significant on univariate and multivariate analysis for event free and overall survival. Cytogenetic high risk patients treated on regimen C had a lower 10 year relapse risk (22.1 % (95% CI 15.1-31.6) compared to those who remained on regimen A/B (52.4 % (95% CI 28.9-80.1, p=0.016), although the OS rates were not significantly different (75.3 % (95% CI 65.8-82.5) vs 66.7 % (95%CI 37.5-84.6), p=0.3). The ten year cumulative incidence of second tumours was 1.16 %( 95 % CI 0.74-1.82). 521 MRD low risk patients were randomised (260 assigned to one delayed intensification and 261 to two delayed intensifications). The 10-year EFS was 91.7 % (95% CI 85.7-94.0) with one course of delayed intensification vs 93.7 % (95% CI 90.0-96.1) with two delayed intensifications (adjusted hazard ratio 0.73, (95% CI 0.38-1.40) p=0.3). The 10-year overall survival was 97.1 % (95 % CI 94.0-98.6) with one delayed intensification and 97.6 % (95 % CI 94.7-98.9) with two delayed intensifications (adjusted hazard ratio 0.69 % (95 % CI 0.24-1.99) P=0.5. 533 MRD high risk patients were randomised (266 assigned standard therapy and 267 assigned to augmented therapy). The 10-year EFS (was 82.1% (95 % CI 76.9-86.2) with standard therapy vs 87.1 % (95 % CI 82.4-90.6) with augmented therapy (adjusted hazard ratio 0.68 (95 % CI 0.44-1.06) p=0.09). The 10-year OS was 87.9 % (95% CI 83.2-91.4) with standard therapy vs 90.7 % (95 % CI 86.4-93.7) (adjusted hazard ratio 0.74(95%CI 0.44-1.27) p=0.3. The loss of significance in EFS between 5 and 10 years was due to additional relapses since the original publication, in the augmented arm. Nevertheless, there remained a benefit for augmented therapy in reducing marrow relapses: cumulative incidence of marrow relapse was 10.4% (95% CI 7.2-14.9) in standard arm vs 5.9% (95% CI 3.6-9.6) (adjusted hazard ratio 0.55 (0.28-1.03) p=0.06. Long term outcome of UKALL 2003 confirms that low risk patients can safely de-escalate therapy and intensified therapy benefits high risk patients, especially those with high-risk cytogenetics. Disclosures Samarasinghe: AMGEN,JAZZ: Honoraria.

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A Novel Epigenetic Machine Learning Model to Define Risk of Progression for Hepatocellular Carcinoma Patients

International Journal of Molecular Sciences ◽

10.3390/ijms22031075 ◽

2021 ◽

Vol 22 (3) ◽

pp. 1075

Author(s):

Luca Bedon ◽

Michele Dal Bo ◽

Monica Mossenta ◽

Davide Busato ◽

Giuseppe Toffoli ◽

...

Keyword(s):

Machine Learning ◽

Hepatocellular Carcinoma ◽

High Risk ◽

Progression Free Survival ◽

Low Risk ◽

Functional Enrichment ◽

Free Survival ◽

High Risk Patients ◽

Risk Of Progression ◽

Risk Patients

Although extensive advancements have been made in treatment against hepatocellular carcinoma (HCC), the prognosis of HCC patients remains unsatisfied. It is now clearly established that extensive epigenetic changes act as a driver in human tumors. This study exploits HCC epigenetic deregulation to define a novel prognostic model for monitoring the progression of HCC. We analyzed the genome-wide DNA methylation profile of 374 primary tumor specimens using the Illumina 450 K array data from The Cancer Genome Atlas. We initially used a novel combination of Machine Learning algorithms (Recursive Features Selection, Boruta) to capture early tumor progression features. The subsets of probes obtained were used to train and validate Random Forest models to predict a Progression Free Survival greater or less than 6 months. The model based on 34 epigenetic probes showed the best performance, scoring 0.80 accuracy and 0.51 Matthews Correlation Coefficient on testset. Then, we generated and validated a progression signature based on 4 methylation probes capable of stratifying HCC patients at high and low risk of progression. Survival analysis showed that high risk patients are characterized by a poorer progression free survival compared to low risk patients. Moreover, decision curve analysis confirmed the strength of this predictive tool over conventional clinical parameters. Functional enrichment analysis highlighted that high risk patients differentiated themselves by the upregulation of proliferative pathways. Ultimately, we propose the oncogenic MCM2 gene as a methylation-driven gene of which the representative epigenetic markers could serve both as predictive and prognostic markers. Briefly, our work provides several potential HCC progression epigenetic biomarkers as well as a new signature that may enhance patients surveillance and advances in personalized treatment.

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Development and validation of the immune signature to predict distant metastasis in patients with nasopharyngeal carcinoma

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2019-000205 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000205 ◽

Cited By ~ 2

Author(s):

Sai-Lan Liu ◽

Li-Juan Bian ◽

Ze-Xian Liu ◽

Qiu-Yan Chen ◽

Xue-Song Sun ◽

...

Keyword(s):

High Risk ◽

Nasopharyngeal Carcinoma ◽

Distant Metastasis ◽

Low Risk ◽

Reliable Estimate ◽

Free Survival ◽

Training Cohort ◽

Immune Signature ◽

High Risk Patients ◽

Risk Patients

BackgroundThe tumor immune microenvironment has clinicopathological significance in predicting prognosis and therapeutic efficacy. We aimed to develop an immune signature to predict distant metastasis in patients with nasopharyngeal carcinoma (NPC).MethodsUsing multiplexed quantitative fluorescence, we detected 17 immune biomarkers in a primary screening cohort of 54 NPC tissues presenting with/without distant metastasis following radical therapy. The LASSO (least absolute shrinkage and selection operator) logistic regression model used statistically significant survival markers in the training cohort (n=194) to build an immune signature. The prognostic and predictive accuracy of it was validated in an external independent group of 304 patients.ResultsEight statistically significant markers were identified in the screening cohort. The immune signature consisting of four immune markers (PD-L1+ CD163+, CXCR5, CD117) in intratumor was adopted to classify patients into high and low risk in the training cohort and it showed a high level of reproducibility between different batches of samples (r=0.988 for intratumor; p<0.0001). High-risk patients had shorter distant metastasis-free survival (HR 5.608, 95% CI 2.619 to 12.006; p<0.0001) and progression-free survival (HR 2.798, 95% CI 1.498 to 5.266; p=0·001). The C-indexes which reflected the predictive capacity in training and validation cohort were 0.703 and 0.636, respectively. Low-risk patients benefited from induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) (HR 0.355, 95% CI 0.147 to 0.857; p=0·021), while high-risk patients did not (HR 1.329, 95% CI 0.543 to 3.253; p=0·533). To predict the individual risk of distant metastasis, nomograms with the integration of both immune signature and clinicopathological risk factors were developed.ConclusionsThe immune signature provided a reliable estimate of distant metastasis risk in patients with NPC and might be applied to identify the cohort which benefit from IC+CCRT.

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Early Detection of WT1 Measurable Residual Disease Identifies High-Risk Patients Independently of Transplantation in AML

Blood Advances ◽

10.1182/bloodadvances.2021004322 ◽

2021 ◽

Author(s):

Juliette Lambert ◽

Jerome Lambert ◽

Xavier Thomas ◽

Alice MARCEAU-RENAUT ◽

Jean-Baptiste Micol ◽

...

Keyword(s):

High Risk ◽

Prognostic Value ◽

Residual Disease ◽

Free Survival ◽

High Risk Patients ◽

Post Induction ◽

Potential Marker ◽

Risk Patients ◽

Measurable Residual Disease ◽

Risk Of Relapse

WT1 overexpression is frequently identified in acute myeloid leukemia (AML) and has been reported as a potential marker for measurable residual disease (MRD) monitoring. Here, we evaluated the value of post-induction WT1 MRD level as a prognostic factor, as well as the interaction between post-induction WT1 MRD response and the effect of allogeneic stem cell transplantation (allo-SCT) in first complete remission (CR). In the ALFA-0702 trial, AML patients aged 18 to 59 years had a prospective quantification of WT1 MRD. Occurrence of a WT1 MRD ratio >2.5% in bone marrow or >0.5% in peripheral blood was defined as MRDhigh, while ratio under these thresholds was defined as MRDlow. The prognostic value of MRD after induction chemotherapy was assessed in 314 patients in first CR by comparing the risk of relapse, the relapse-free survival (RFS) and the overall survival (OS). Interaction between MRD response and allo-SCT effect was evaluated in patients by comparing the influence of allo-SCT on the outcomes of patients with MRDhigh and MRDlow. We showed that MRDhigh patients after induction had a higher risk of relapse and a shorter RFS and OS. MRD response remained of strong prognostic value in the subset of 225 patients with intermediate/unfavorable-risk AML, eligible for allo-SCT, since MRDhigh patients had a significantly higher risk of relapse resulting in worse RFS and OS. Effect of allo-SCT was higher in MRDlow patients than in MRDhigh patients but not statistically different. Early WT1 MRD response highlight a population of high-risk patients in need of additional therapies.

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CODOX-M/IVAC (NCI 89-C-41) for Children and Adolescents with Small Non-Cleaved and Large B-Cell Lymphomas. A 14 Years Monocentric Experience.

Blood ◽

10.1182/blood.v104.11.3308.3308 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3308-3308

Author(s):

Maria Luisa Moleti ◽

Anna Maria Testi ◽

Luigi Malandruccolo ◽

Elisabetta Todisco ◽

Edoardo Pescarmona ◽

...

Keyword(s):

High Risk ◽

Children And Adolescents ◽

Stage Iv ◽

Low Risk ◽

High Dose ◽

Event Free Survival ◽

Free Survival ◽

High Risk Patients ◽

Risk Patients ◽

Large B Cell

Abstract Over the last 14 years, at our Institute, we have used the NCI 89-C-41 protocol designed by I. Magrath in children and adolescents with small non-cleaved cell (SNCL) and large B-cell (LBCL) lymphomas. In the 1996 paper (J Clin Oncol 1996, 14: 925–34), Magrath et al reported an event-free survival of 92% at 2 years, in adults and children with SNCL. In this protocol, patients with a single extra-abdominal mass or completely resected abdominal disease and LDH <350 IU/L are classified as low-risk; all other patients are defined as high-risk. Low-risk patients receive 3 cycles of the CODOX-M regimen, a combination of cyclophosphamide, doxorubicin, prednisone, vincristine, high-dose methotrexate and intrathecal therapy. High-risk patients receive 4 alternating CODOX-M and IVAC regimens. The IVAC protocol includes ifosfamide, etoposide, high-dose cytarabine and intrathecal methotrexate. We describe hereby the results obtained in 35 patients younger than 21 years with SNCL and LCBL, seronegative for the HIV, treated with the NCI 89-C-41 protocol between September 1989 and March 2003 at our Institute. Median age at presentation was 12.1 years, ranging form 2.6 to 21 years. Thirty patients had SNCL and 5 LBCL. According to Murphy’s staging system, 17 were classified as stage II, 9 as stage III and 9 as stage IV (all with bone marrow involvement that was >25% in 3; 1 with associated CNS disease). Two patients were defined as low risk, while 33 were high-risk. The CNS+ patient received additional IT therapy. G-CSF was given in case of neutropenia associated to severe infections. Thirty-two of the 35 patients (91%) achieved a CR. The remaining 3 patients (SNCL, stages II, III and IV) obtained a PR after the first 2 cycles, but the disease rapidly progressed and led to death in all 3. One patient with stage IV SNCL died in CR of fungal meningitis, during the fourth cycle neutropenia. Three complete responders (SNCL, stage III) relapsed after 2, 2 and 33 months from the end of therapy. Only 1 of them is alive and well in second CR after a stem cell transplant. A life-threatening tumor lysis syndrome was observed in 2 patients; metabolic alterations caused seizures in 1 of them that resolved without sequelae. The hematological toxicity was acceptable; in low-risk patients no thrombocytopenias were observed and neutropenia lasted from 0 to 3 days. For high-risk patients, the median time to PMN >0.5 x 109/L after each cycle was 7, 6, 6 and 6 days (range 0–19), respectively, and to PLTS >50 x 109/L was 6 days (range 0–36). Infections were observed only in high-risk patients with 13 bacterial sepsis, 1 disseminated fungal infection and 12 localized infections. Mucositis (WHO >2) was the main extra-hematological side-effect occurring usually after the CODOX-M regimen; transient peripheral neuropathy occurred in 4 patients after the CODOX-M cycle. No acute and late liver, pulmonary and cardiac toxicities were registered. The 7-years overall survival and event free-survival are 83 and 80%. The results of our study indicate that the NCI 89-C-41 protocol, originally designed for SNCL patients, has confirmed its feasibility and documented its long-term efficacy in a series of children and adolescents with both SNCL and LBCL managed at a single center and with a median follow-up extended to 10 years.

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Aspirin and Growth of Small Unruptured Intracranial Aneurysm

Stroke ◽

10.1161/strokeaha.120.029967 ◽

2020 ◽

Vol 51 (10) ◽

pp. 3045-3054

Author(s):

Jian-Cong Weng ◽

Jie Wang ◽

Hao Li ◽

Yu-Ming Jiao ◽

Wei-Lun Fu ◽

...

Keyword(s):

Blood Pressure ◽

High Risk ◽

Intracranial Aneurysm ◽

Blood Pressure Level ◽

Hazard Ratio ◽

Low Risk ◽

Unruptured Intracranial Aneurysm ◽

High Risk Patients ◽

Risk Patients

Background and Purpose: The role of aspirin in unruptured intracranial aneurysm (UIA) growth remains largely unknown. We aim to identify whether aspirin is associated with a lower rate of UIA growth in patients with UIA <7 mm. Methods: This prospective cohort study consecutively enrolled patients with UIAs <7 mm with ischemic cerebrovascular disease between January 2016 and December 2019. Baseline and follow-up patient information, including the use of aspirin and blood pressure level, were recorded. Patients were considered aspirin users if they took aspirin, including standard- and low-dose aspirin, ≥3× per week. The primary end point was aneurysm growth in any direction or an indisputable change in aneurysm shape. Results: Among the 315 enrolled patients, 272 patients (86.3%) underwent imaging examinations during follow-up (mean follow-up time, 19.6±12.7 months). A total of 113 patients were continuously treated with aspirin. UIA growth occurred in 31 (11.4%) patients. In the multivariate Cox analysis, specific aneurysm locations (anterior communicating artery, posterior communicating artery, or middle cerebral artery; hazard ratio, 2.89 [95% CI, 1.22–6.88]; P =0.016) and a UIA size of 5 to <7 mm (hazard ratio, 7.61 [95% CI, 3.02–19.22]; P <0.001) were associated with a high risk of UIA growth, whereas aspirin and well-controlled blood pressure were associated with a low risk of UIA growth (hazard ratio, 0.29 [95% CI, 0.11–0.77]; P =0.013 and hazard ratio, 0.25 [95% CI, 0.10–0.66]; P =0.005, respectively). The cumulative annual growth rates were as high as 40.0 and 53.3 per 100 person-years in the high-risk patients (>1 risk factor) with and without aspirin, respectively. Conclusions: Aspirin therapy and well-controlled blood pressure are associated with a low risk of UIA growth; the incidence of UIA growth in high-risk patients in the first year is high, warranting intensive surveillance in this patient group. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02846259.

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The beneficial role of Asian-based RecurIndex test in the prognostic prediction in Chinese male breast cancer patients

Scientific Reports ◽

10.1038/s41598-021-87267-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shuo Zhang ◽

Beichen Liu ◽

Mengli Zhou ◽

Jintian Wang ◽

Jinzhao Liu ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Local Recurrence ◽

Male Breast Cancer ◽

Distant Recurrence ◽

Low Risk ◽

Free Survival ◽

High Risk Patients ◽

Risk Patients ◽

N Stage

AbstractRecurIndex, a multigene profiling assay, can predict the risk of local recurrence and distant metastasis in female breast cancer (FBC), but its role in male breast cancer (MBC) remains unclear. In this study, the clinicopathological data of 43 consecutive MBC patients undergoing surgeries between 2009 and 2018 were retrospectively analysed. Their paraffin-embedded tissue sections were examined by RecurIndex test which comprised 2 models: recurrence index for local recurrence (RI-LR) and recurrence index for distant recurrence (RI-DR). Of 43 patients, there were 26 low-risk and 17 high-risk patients assessed by RI-LR, while 17 low-risk and 26 high-risk patients by RI-DR. For RI-LR, tumor N stage showed statistically significant (P < 0.001) between low- and high-risk patients; for RI-DR, differences were pronounced in tumor grade (P = 0.033), T stage (P = 0.043) and N stage (P = 0.003). In terms of clinical outcomes, the overall survival (OS) of low- and high-risk patients stratified by RI-LR showed no statistically significant differences (P = 0.460), while high-risk patients identified by RI-DR had a significantly worse distant recurrence-free survival (DRFS) (P = 0.035), progression-free survival (PFS) (P = 0.019) and OS (P = 0.044) than low-risk patients. Overall, RI-DR can effectively predict the DRFS, PFS and OS of MBC patients and identify those at low risk of recurrence, which may serve as a potential prognostic tool for MBC.

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Evaluation of the Disease Risk Index on Outcomes Following Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndromes

Blood ◽

10.1182/blood.v124.21.2529.2529 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2529-2529

Author(s):

Fotios V. Michelis ◽

Hans A. Messner ◽

Jieun Uhm ◽

Naheed Alam ◽

David Loach ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Myeloid Leukemia ◽

Hematopoietic Cell Transplantation ◽

Disease Risk ◽

Risk Index ◽

Low Risk ◽

High Risk Patients ◽

Risk Patients ◽

Acute Myeloid

Abstract Allogeneic hematopoietic cell transplantation (HCT) is a curative treatment option when indicated for myeloid malignancies such as acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). The Disease Risk Index (DRI, Armand et al, 2012) has been developed to predict overall survival and progression-free survival on the basis of differences in relapse risk. The purpose of this single-center study was to retrospectively investigate the prognostic value of the DRI on the outcome of 470 patients that underwent HCT for AML and MDS between 2000 and 2013. AML patients (n=381) underwent HCT in first and second complete remission and MDS patients (n=89) underwent HCT untreated or in remission. Median age at HCT was 51 (range 18-71), 219 (47%) patients were female. Myeloablative conditioning (MAC) was used in 304 (65%) patients, reduced-intensity (RIC) in 166 (35%) patients. Donors were related for 287 (61%) patients, unrelated for 183 (39%) patients. Grafts were peripheral blood stem cells (PBSC) in 377 (80%) patients and bone marrow in 93 (20%) patients. Median follow-up of patients alive was 44 months (range 1-134). In accordance with the DRI criteria, all 470 patients were in the low risk group concerning disease stage. Concerning disease biology characterized by cytogenetic risk, 11 patients were low risk, 396 patients were intermediate risk and 63 patients high risk. Based on the DRI overall risk stratification, 11, 396 and 63 patients were low, intermediate and high risk respectively. Univariate analysis demonstrated that the DRI was significantly prognostic for overall survival (OS) with a 3-year OS of 82%, 48% and 29% for low, intermediate and high risk patients respectively (p=0.005, Figure A). For cumulative incidence of relapse (CIR), DRI was again prognostic with 3-year CIR 0%, 21% and 30% for low, intermediate and high risk patients respectively (p<0.0001, Figure B). For non-relapse mortality (NRM), DRI did not demonstrate significant prognostic relevance with 3-year NRM 18%, 32% and 43% for low, intermediate and high risk patients respectively (p=0.14). Multivariable analysis for OS confirmed the prognostic significance of the DRI with hazard ratio (HR) 3.3 and 4.9 for intermediate and high risk respectively compared to low risk (p=0.01). For CIR, DRI was highly significant (p<0.0001) while for NRM, the DRI was not predictive (p=0.22). This study confirms the prognostic relevance of the DRI for OS and CIR in our cohort of patients undergoing HCT for AML and MDS. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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Immune Reconstitution-Based Score for Risk Stratification of Chronic Graft-Versus-Host Disease Patients

Frontiers in Oncology ◽

10.3389/fonc.2021.705568 ◽

2021 ◽

Vol 11 ◽

Author(s):

Fabio Serpenti ◽

Francesca Lorentino ◽

Sarah Marktel ◽

Raffaella Milani ◽

Carlo Messina ◽

...

Keyword(s):

Overall Survival ◽

High Risk ◽

Risk Stratification ◽

Immune Reconstitution ◽

Validation Cohort ◽

Multivariate Model ◽

Low Risk ◽

Intermediate Risk ◽

High Risk Patients ◽

Risk Patients

IntroductionAllogeneic stem cell transplantation survivors are at a relevant risk of developing chronic GvHD (cGvHD), which importantly affects quality of life and increases morbidity and mortality. Early identification of patients at risk of cGvHD-related morbidity could represent a relevant tool to tailor preventive strategies. The aim of this study was to evaluate the prognostic power of immune reconstitution (IR) at cGvHD onset through an IR-based score.MethodsWe analyzed data from 411 adult patients consecutively transplanted between January 2011 and December 2016 at our Institution: 151 patients developed cGvHD (median follow-up 4 years). A first set of 111 consecutive patients with cGvHD entered the test cohort while an additional consecutive 40 patients represented the validation cohort. A Cox multivariate model for OS (overall survival) in patients with cGvHD of any severity allowed the identification of six variables independently predicting OS and TRM (transplant-related mortality). A formula for a prognostic risk index using the β coefficients derived from the model was designed. Each patient was assigned a score defining three groups of risk (low, intermediate, and high).ResultsOur multivariate model defined the variables independently predicting OS at cGvHD onset: CD4+ >233 cells/mm3, NK <115 cells/mm3, IgA <0.43g/L, IgM <0.45g/L, Karnofsky PS <80%, platelets <100x103/mm3. Low-risk patients were defined as having a score ≤3.09, intermediate-risk patients >3.09 and ≤6.9, and high-risk patients >6.9. By ROC analysis, we identified a cut-off of 6.310 for both TRM and overall mortality.In the training cohort, the 6-year OS and TRM from cGvHD occurrence were 85% (95% CI, 70-92) and 13% (95% CI, 5-25) for low-risk, 64% (95% CI, 44-89) and 30% (95% CI, 15-47) for intermediate-risk, 26% (95% CI, 10-47), and 42% (95% CI, 19-63) for high-risk patients (OS p<0.0001; TRM p = 0.015).The validation cohort confirmed the model with a 6-year OS and TRM of 83% (95% CI, 48-96) and 8% (95% CI, 1-32) for low-risk, 78% (95% CI, 37-94) and 11% (95% CI, 1-41) for intermediate-risk, 37% (95% CI, 17-58), and 63% (95% CI, 36-81) for high-risk patients (OS p = 0.0075; TRM p = 0.0009).ConclusionsIR score at diagnosis of cGvHD predicts GvHD severity and overall survival. IR score may contribute to the risk stratification of patients. If confirmed in a larger and multicenter-based study, IR score could be adopted to identify patients at high risk and modulate cGvHD treatments accordingly in the context of clinical trial.

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