Prediction and Prognostication of Acute Graft-Versus-Host Disease by MAGIC Biomarkers

Abstract

Recent advancements in prophylaxis for acute graft-versus-host disease (GVHD) have successfully reduced the incidence of severe cases; however, overall survival rates have not significantly improved, and GVHD continues to be a major cause of mortality. The severity of gastrointestinal (GI) damage is especially critical, as it strongly correlates with treatment failure and non-relapse mortality, but clinical symptoms do not reliably predict peak severity in its early stages. Biomarker-based algorithms, such as the Mount Sinai Acute GVHD International Consortium (MAGIC) algorithm, leverage serum levels of GI GVHD biomarkers (ST2 and REG3α) to quantify intestinal crypt damage, providing more accurate predictions of GVHD outcomes compared to clinical assessments. Clinical trials have investigated the use of biomarkers as entry criteria for treatment, with notable success in guiding treatment de-escalation, which is increasingly important as the presentation of GVHD shifts towards milder forms. The recently developed MAGIC composite scores further enhance prediction accuracy by integrating clinical symptom severity with biomarker assessments. Future clinical trials that employ these composite scores or similar algorithms are anticipated to be more efficient by identifying patients who are most likely to benefit from specific therapies and ultimately improving the management of GVHD.