Only approximately 50% of patients have steroid-responsive aGVHD. Pre-HSCT co-morbidity is a critical factor in both probability of developing aGVHD and mortality after it. Current risk-stratification models do not take into account endothelial factors, including VEGF and thrombomodulin production, and gut microbiota, all of which influence healing and potential for steroid-responsiveness. A refined Minnesota risk score based on severity of symptoms and number of organ systems involved was recently published. Serum biomarkers including TNFR1, REG3α, andST2 may also be incorporated in the future.
* Risk stratification for aGVHD is improving but is not yet able to prognosticate with certainty or help dictate treatment.