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Prediction of response and long-term outcomes of second-line therapy for patients with aGvHD: A MAGIC analysis

Jun 12, 2024
Learning objective: After reading this article, learners will be able to cite a new clinical development in acute GvHD.

An analysis evaluating the association between the Mount Sinai Acute Graft-versus-Host Disease (aGvHD) International Consortium (MAGIC) algorithm probabilities (MAP), measured at the initiation of second-line therapy, and Day 28 response and long-term outcomes, in patients with aGvHD, was published in Blood Advances by DeFilipp et al.1 Clinical data and serum samples from 167 patients who received second-line systematic treatment for aGvHD between January 2016 and December 2021 were analyzed from the MAGIC database and biorepository.1  

Key learnings:
Compared with other second-line therapies for aGvHD, ruxolitinib was associated with improved outcomes (Day 28 overall response: 55% vs 31%, p=0.003; 2-year non-relapse mortality [NRM] point estimates: 12% vs 41%; 2-year overall survival [OS] point estimates: 79% vs 52%); however, this benefit was limited to patients with low MAP. 
For lower-risk patients (low MAP) at initiation of second-line therapy, ruxolitinib should be considered standard of care; however, for higher-risk patients (high MAP), exploring new therapies or combination treatments in clinical trials is warranted to improve outcomes. 
Therefore, MAP at initiation of second-line therapy for aGVHD is a significant predictor of NRM and overall survival (OS). 
Overall, despite the studys retrospective nature and limited sample size, these findings suggest that integrating MAP into clinical practice could personalize treatment approaches for aGVHD, optimizing therapeutic strategies and improving patient outcomes. 
In addition, incorporating MAP into clinical trial designs for steroid-refractory aGVHD could enhance the relevance of trial outcomes, particularly in non-randomized studies. 

  1. DeFilipp Z, Kim HT, Spyrou N, et al. The MAGIC algorithm probability predicts treatment response and long-term outcomes to second-line therapy for acute GVHD. Blood Adv. 2024. Online ahead of print. DOI:10.1182/bloodadvances.2024012561 


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