Research in context
Evidence before this study
Most patients with graft-versus-host disease (GVHD) after allogeneic stem-cell transplantation (alloSCT) improve when treated with steroids. However, a subset of patients is resistant to treatment with steroids and has a high mortality. Early identification of those steroid-refractory patients (eg, at onset of GVHD) could be the basis of risk-adapted treatment strategies. To identify previous publications, we searched PubMed for manuscripts published in English only between Jan 1, 1980, and Feb 8, 2017, with the terms “prediction”, “outcome”, “mortality”, “biomarker”, “steroid-refractory”, “graft-versus-host disease”, and “GVHD”. This search retrieved several studies reporting that biomarkers can be used to predict GVHD outcome. However, few of the published biomarkers were validated in independent cohorts, and none of those has the potential of fast clinical implementation. The underlying basis for our present study was recent findings on the importance of endothelial biology for GVHD pathophysiology.
Added value of this study
This study provides a standard laboratory biomarker panel that can be used to predict the patient's individual risk of mortality after GVHD onset. The Endothelial Activation and Stress Index (EASIX) online calculator is free to the public, enabling use of the algorithm by all interested parties.
Implications of all the available evidence
Risk-adapted treatment strategies for GVHD are needed to avoid steroid overtreatment in patients at low risk of GVHD and to reduce mortality in the high-risk cohorts. The EASIX-GVHD has the potential to serve as a tool for clinical decision making in patients with GVHD.