Disease risk and GVHD biomarkers can stratify patients for risk of relapse and nonrelapse mortality post hematopoietic cell transplant

M.D. Aziz, J. Shah, U. Kapoor, C. Dimopoulos, S. Anand, A. Augustine, F. Ayuk, M. Chaudhry, Y.-B. Chen, H.K. Choe, A. Etra, S. Gergoudis, M.J. Hartwell, E.O. Hexner, W.J. Hogan, C.L. Kitko, S. Kowalyk, N. Kröger, P. Merli, G. MoralesR. Nakamura, R. Ordemann, M.A. Pulsipher, M. Qayed, R. Reshef, W. Rösler, T. Schechter, E. Schreiner, H. Srinagesh, M. Wölfl, K. Wudhikarn, G. Yanik, R. Young, U. Özbek, J.L.M. Ferrara, J.E. Levine

Research output: Contribution to journalArticlepeer-review


The graft-versus-leukemia (GVL) effect after allogeneic hematopoietic cell transplant (HCT) can prevent relapse but the risk of severe graft-versus-host disease (GVHD) leads to prolonged intensive immunosuppression and possible blunting of the GVL effect. Strategies to reduce immunosuppression in order to prevent relapse have been offset by increases in severe GVHD and nonrelapse mortality (NRM). We recently validated the MAGIC algorithm probability (MAP) that predicts the risk for severe GVHD and NRM in asymptomatic patients using serum biomarkers. In this study we tested whether the MAP could identify patients whose risk for relapse is higher than their risk for severe GVHD and NRM. The multicenter study population (n = 1604) was divided into two cohorts: historical (2006–2015, n = 702) and current (2015–2017, n = 902) with similar NRM, relapse, and survival. On day 28 post-HCT, patients who had not developed GVHD (75% of the population) and who possessed a low MAP were at much higher risk for relapse (24%) than severe GVHD and NRM (16 and 9%); this difference was even more pronounced in patients with a high disease risk index (relapse 33%, NRM 9%). Such patients are good candidates to test relapse prevention strategies that might enhance GVL. © 2020, The Author(s), under exclusive licence to Springer Nature Limited.
Original languageEnglish
Pages (from-to)1898-1906
Number of pages9
Issue number7
Publication statusPublished - 2020


  • biological marker
  • calcineurin inhibitor
  • cyclophosphamide
  • methotrexate
  • mycophenolate mofetil
  • rapamycin
  • tacrolimus
  • thymocyte antibody
  • acute leukemia
  • adolescent
  • adult
  • aged
  • algorithm
  • allogeneic hematopoietic stem cell transplantation
  • Article
  • cause of death
  • child
  • cohort analysis
  • female
  • graft versus host reaction
  • graft versus leukemia effect
  • human
  • immunosuppressive treatment
  • incidence
  • low risk patient
  • lymphoma
  • major clinical study
  • male
  • multicenter study
  • myelodysplastic syndrome
  • myeloproliferative neoplasm
  • priority journal
  • recurrence risk
  • risk assessment
  • allotransplantation
  • blood
  • epidemiology
  • follow up
  • hematologic disease
  • hematopoietic stem cell transplantation
  • mortality
  • prognosis
  • risk factor
  • survival rate
  • transplantation conditioning
  • tumor recurrence
  • Algorithms
  • Biomarkers
  • Follow-Up Studies
  • Graft vs Host Disease
  • Hematologic Neoplasms
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Neoplasm Recurrence, Local
  • Prognosis
  • Risk Factors
  • Survival Rate
  • Transplantation Conditioning
  • Transplantation, Homologous


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