303: Incidence and outcome of chronic graft-versus-host disease (cGVHD) after allogeneic stem cell transplant (SCT) using National Institute of Health (NIH) consensus criteria

Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD

“…One of the previous studies showed decreased survival among patients with overlap syndrome compared with classic chronic GVHD at onset according to NIH criteria, 12 but other studies showed similar survival among patients in these 2 groups. 13,14 Jagasia et al 12 showed that the presence of acute GVHD manifestations was associated with decreased survival among patients with historically defined chronic GVHD.…”

“…The proportion of patients with late acute GVHD at onset was 48% in our study, higher than the 15% to 37% proportions reported in retrospective studies from centers where medical providers may have more frequent direct contact with patients. [11][12][13][14] It is probable that our results overestimate the true proportion of patients with late acute GVHD because our analysis relied on available documentation, which might not have been sufficient to ascertain the presence of NIH criteria. Prospective studies with evaluation by appropriately trained medical providers will be needed to assess the true incidence and onset of NIH criteria among patients with GVHD more than 100 days after HCT.…”

“…[11][12][13][14] Three previous studies showed an increased risk of nonrelapse mortality or worse overall survival among patients with late acute GVHD at onset compared with those with classic chronic GVHD or overlap syndrome at onset. 11,12,14 Our results are similar to those reported by Cho et al, 13 who found no statistically significant differences in "GVHD-specific survival" between patients with late acute GVHD compared with those with NIH chronic GVHD at onset. The discrepant results among these studies may be explained by differences in historical criteria used to make the diagnosis of chronic GVHD in the respective centers and by inadequacies of medical records in documenting the presence or absence of diagnostic and distinctive manifestations of chronic GVHD according to NIH consensus criteria.…”

“…13,14 Jagasia et al 12 showed that the presence of acute GVHD manifestations was associated with decreased survival among patients with historically defined chronic GVHD. We could not analyze the association of acute GVHD manifestations with outcomes among patients with historically defined chronic GVHD for 2 reasons.…”

Time to first flare-up episode of GVHD can stratify patients according to their prognosis during clinical course of progressive- or quiescent-type chronic GVHD

“…In addition, since patients were ascertained and categorized before establishment of the NIH consensus criteria for diagnosis and staging of cGVHD, 5 our cohort may include some patients with late-onset acute GVHD, a powerful adverse prognostic factor for GSS. 16,17 Therefore, this limitation needs to be addressed prospectively in future trials, using more controlled tapering schedules of systemic immunosuppressive treatments.…”