ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1660861
Age-Enhanced MAGIC Algorithm Predicts Mortality in Pediatric aGVHD: A Multicenter Study
Provisionally accepted
- 1The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Changsha, China
- 2Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 3The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- 4Beijing BFR Gene Diagnostics Co Ltd, Beijing, China
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Acute graft-versus-host disease (aGVHD) significantly contributes to non-relapse mortality (NRM) in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the MAGIC algorithm (based on plasma sST2 and REG3α) has been effective in assessing aGVHD risk in adults, pediatric validation remains limited. This study involved a prospective multicenter analysis of 105 Chinese pediatric allo-HSCT recipients diagnosed with aGVHD. Using the MAGIC-derived Panel 2 scores, patients were categorized into high and low risk groups based on the 75th percentile cutoff, which allowed for the prediction of 6-month NRM. A multivariable analysis revealed that age ≥ 12 years (HR 4.36, 95% CI 1.62–11.75; P=0.003) and a high Panel 2 score (HR 3.09, 95% CI 1.08–8.82; P=0.035) were independent predictors of 6-month NRM and overall survival (OS). The combination of these factors established distinct risk categories: high-risk (age≥12 + high Panel 2; NRM 71%) versus low-risk (all others; NRM 12.2%) with significant NRM difference (HR 5.00, 95% CI 1.75–9.56; P=0.001) and OS divergence (P<0.001). Furthermore, decision-curve analysis indicated that the integrated model (age + panel 2) offered a greater net clinical benefit. Overall, the MAGIC algorithm has proven effective in predicting NRM and OS in pediatric allo-HSCT patients with aGVHD, and incorporating age ≥12 years enhances risk stratification, thereby supporting its clinical application in pediatric patients.
Keywords: Acute graft-versus-host disease, allogeneic hematopoietic stem cell transplantation, Non-relapse mortality, MAGIC algorithm, pediatric, risk stratification
Received: 07 Jul 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Song, XIONG, Zhang, Wang, Xu, Cheng, He and Deng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Benshan Zhang, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Changsha, China
Dao Wang, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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