Manhattan Risk and MAGIC Composite Score Calculator

Enter aGVHD staging for each target organ at the initiation of systemic treatment

Skin

Stage 0 - no GVHD rash Stage 1 - <25% BSA Stage 2 - 25-50% BSA Stage 3 - >50% BSA Stage 4 - Generalized rash (>50% BSA) with bullous formation and/or desquamation >5%

Liver

Stage 0 - Total Bilirubin <2.0 mg/dl or non-GVHD hyperbilirubinemia Stage 1 - Total Bilirubin 2.0-3.0 mg/dl Stage 2 - Total Bilirubin 3.1-6.0 mg/dl Stage 3 - Total Bilirubin 6.1-15.0 mg/dl Stage 4 - Total Bilirubin >15.0 mg/dl

Upper GI

Stage 0 - no persistent N/V/A or N/V/A from non-GVHD causes Stage 1 - persistent N/V/A

Lower GI Adult Child <50kg

Stage 0 - Diarrhea <500 ml/day or non-GVHD diarrhea Stage 1 - Diarrhea 500-999 ml/day Stage 2 - Diarrhea 1000-1500 ml/day Stage 3 - Diarrhea >1500 ml/day Stage 4 - Severe abdominal pain with or without ileus or grossly bloody stool (volume independent)

Legend/Help Text:

N/V/A - Nausea, Vomiting, Anorexia
Persistent N/V/A
1. Nausea lasting >3 days and/or
2. >2 vomiting episodes per day for at least 2 days and/or
3. Anorexia with weight loss
If diarrhea is reported in episodes: 1 episode = 200 mL

The Manhattan Risk is: Low

Estimated Day 28 ORR: 77%

Estimated 6-month NRM: 7.0%

The Manhattan Risk is: Intermediate

Estimated Day 28 ORR: 70%

Estimated 6-month NRM: 15%

The Manhattan Risk is: High

Estimated Day 28 ORR: 49%

Estimated 6-month NRM: 36%

Not applicable

Enter Ann Arbor (AA) scoring at the initiation of systemic treatment below to calculate MAGIC Composite Score

AA Score

1 2 3

The MAGIC algorithm probability (MAP) is calculated as follows ^{1, 2}

log[–log(1 – MAP)] = –11.263 + 1.844(log₁₀ST2) + 0.577(log₁₀REG3α)

Thresholds of MAP in each Ann Arbor (AA) score

AA1: 0.001-0.140

AA2: 0.141-0.290

AA3: 0.291-0.999

1. Hartwell MJ, Ozbek U, Holler E, et al. An early-biomarker algorithm predicts lethal graft-versus-host disease and survival. JCI Insight. 2018;3(16).

2. Akahoshi Y, Spyrou N, Hogan WJ, et al. Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD. Blood Adv. 2023;7(16):4479-4491.

The MAGIC Composite Score is: 1

Estimated Day 28 ORR: 80%

Estimated 6-month NRM: 5.7%

The MAGIC Composite Score is: 2

Estimated Day 28 ORR: 63%

Estimated 6-month NRM: 29%

The MAGIC Composite Score is: 3

Estimated Day 28 ORR: 30%

Estimated 6-month NRM: 52%

Akahoshi Y, Spyrou N, Weber D, et al.

Blood.2024;144(9):1010-1021.

DOI: 10.1182/blood.2024025106