MAGIC Biomarker Staging: Predicting Non-Relapse Mortality (NRM) using serum concentrations of ST2 and Reg3α. Note: Formal MAGIC calculation requires specific laboratory standardization.
Marker of systemic inflammation
Marker of GI crypt damage
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Prognostic assessment of patients at the onset of Grade I–IV acute Graft-versus-Host Disease (aGvHD).
To predict the probability of Non-Relapse Mortality (NRM) independent of clinical severity.
Identifying "high-risk" patients who may benefit from augmented first-line or early second-line therapy.
Patient Population
Adult and pediatric patients following allogeneic hematopoietic cell transplantation (alloHCT) who develop clinical aGvHD.
Section 2
Formula & Logic
Primary MAGIC Biomarkers
Biomarker
Significance
ST2
Marker of systemic inflammation and endothelial distress; predictor of steroid-refractory GvHD.
Reg3α
Marker of intestinal crypt damage; specific for gastrointestinal GvHD.
Ann Arbor Staging (Biomarker-based)
Stage
Risk Level
6-month NRM (%)
1
Low Risk
5 - 10%
2
Intermediate Risk
20 - 25%
3
High Risk
40 - 50%
Section 3
Pearls/Pitfalls
Biomarkers vs. Symptoms
Biomarkers often reveal the biological severity of aGvHD before the full clinical phenotype emerges. For example, a patient with mild (Stage 1) skin and GI symptoms but High-Risk MAGIC biomarkers has a significantly higher hazard of death than a patient with severe symptoms but Low-Risk biomarkers.
Section 4
Evidence Appraisal
Primary Score
A biomarker-based algorithm for the diagnosis and risk stratification of acute graft-versus-host disease.
Developed by the Mount Sinai Acute GvHD International Consortium (MAGIC), a group of over 20 transplant centers worldwide dedicated to improving aGvHD monitoring.
Last Comprehensive Review: 2026
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Prognostic assessment of patients at the onset of Grade I–IV acute Graft-versus-Host Disease (aGvHD).
To predict the probability of Non-Relapse Mortality (NRM) independent of clinical severity.
Identifying "high-risk" patients who may benefit from augmented first-line or early second-line therapy.
Patient Population
Adult and pediatric patients following allogeneic hematopoietic cell transplantation (alloHCT) who develop clinical aGvHD.
Section 2
Formula & Logic
Primary MAGIC Biomarkers
Biomarker
Significance
ST2
Marker of systemic inflammation and endothelial distress; predictor of steroid-refractory GvHD.
Reg3α
Marker of intestinal crypt damage; specific for gastrointestinal GvHD.
Ann Arbor Staging (Biomarker-based)
Stage
Risk Level
6-month NRM (%)
1
Low Risk
5 - 10%
2
Intermediate Risk
20 - 25%
3
High Risk
40 - 50%
Section 3
Pearls/Pitfalls
Biomarkers vs. Symptoms
Biomarkers often reveal the biological severity of aGvHD before the full clinical phenotype emerges. For example, a patient with mild (Stage 1) skin and GI symptoms but High-Risk MAGIC biomarkers has a significantly higher hazard of death than a patient with severe symptoms but Low-Risk biomarkers.
Section 4
Evidence Appraisal
Primary Score
A biomarker-based algorithm for the diagnosis and risk stratification of acute graft-versus-host disease.
Developed by the Mount Sinai Acute GvHD International Consortium (MAGIC), a group of over 20 transplant centers worldwide dedicated to improving aGvHD monitoring.