Early and sex-specific dynamic changes of the modified Glasgow Prognostic Score correlate with survival and immunotoxicities in patients undergoing allogeneic hematopoietic stem cell transplantation.

Risk assessment before allogeneic hematopoietic stem cell transplantation (alloHSCT) is essential to estimate treatment-related morbidity and mortality; the hematopoietic cell transplantation-comorbidity index (HCT-CI) is widely used. The modified Glasgow Prognostic Score (mGPS), reflecting systemic inflammation and nutritional status, is a validated prognostic marker in solid tumors, but ill-defined in alloHSCT. We evaluated the prognostic impact of mGPS before and early after alloHSCT on overall survival (OS), non-relapse mortality (NRM), and acute graft-versus-host disease (aGvHD). We analyzed 442 consecutive alloHSCT patients (2012-2017, University Hospital Cologne). Outcomes were assessed by mGPS pre-transplant (preTx), at day+30, and by dynamic changes (Δ30mGPS). Subgroup analyses included transplant characteristics and sex. Patients with mGPS 2 preTx had inferior OS (HR 2.32, p<0.0001) and NRM (HR 2.31, p=0.002). Moreover, Δ30mGPS changes indicated poorer OS and NRM rates more strongly (Δ30mGPS1→2vs0→1: OS: HR 2.85, p=0.02; NRM: HR 3.99, p=0.05). Findings regarding aGvHD were conflicting. Multivariable analysis confirmed mGPS as an independent prognostic factor for survival. Sex-specific analyses revealed distinct risk patterns. These findings highlight the prognostic relevance of the immunonutritional status before and early after alloHSCT, warranting prospective studies to further validate the mGPS for refined risk stratification.