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

Vigorito, Afonso Celso; Campregher, Paulo Vidal; Storer, Barry E.; Carpenter, Paul A.; Moravec, Carina; Kiem, Hans Peter; Fero, Matthew L.; Warren, Edus H.; Lee, Stephanie J.; Appelbaum, Frederick R.; Martin, Paul J.; Flowers, Mary E.D.

doi:10.1182/blood-2009-03-208983

Cited by 224 publications

(200 citation statements)

References 17 publications

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“…aGvHD and cGvHD were scored according to the NIH Consensus Conference and the Glucksberg criteria 23 as described previously in detail. [24][25][26] aGvHD was graded by staging the affected organs, particularly skin, liver and gut (stage 1-4) and subsequently determining an overall grade (grade I-IV). 2 Grading of cGvHD was performed by scoring the organ involvement (score 0-3) and global severity grading (mild, moderate, severe).…”

Section: Patients and Ecp Treatmentmentioning

confidence: 99%

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

Rieber

Wecker

Neri

et al. 2014

Bone Marrow Transplant

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Extracorporeal photopheresis (ECP) is beneficial in patients with T-cell-mediated disorders, including GvHD, but the underlying immunological mechanisms are incompletely understood. Myeloid-derived suppressor cells (MDSCs) are innate immune cells characterized by their capacity to suppress T-cell proliferation. We quantified MDSCs by flow cytometry in peripheral blood from patients after BMT with GvHD before and after ECP treatment, patients after BMT but without GvHD and age-matched healthy controls. MDSC functionality was analyzed using T-cell proliferation, cytokine release and arginase activity. GvHD patients showed increased baseline percentages of neutrophilic MDSCs (PMN-MDSCs) compared with healthy controls and patients after BMT without GvHD. ECP treatment in GvHD patients rapidly increased circulating percentages of PMN-MDSCs. Functionally, PMN-MDSCs efficiently dampened Th1 and Th17 responses and were paralleled by an increase of cellular and extracellular arginase activity. Following ECP longitudinally over 16 weeks, two GvHD responder subgroups were identified, with group one continuously increasing PMN-MDSCs and group two with stable or decreasing PMN-MDSCs over time. This study demonstrates for the first time that ECP increases T-cell-dampening PMN-MDSCs in GvHD patients, a finding that should be confirmed in larger series of GvHD patients.

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Section: Patients and Ecp Treatmentmentioning

confidence: 99%

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

Rieber

Wecker

Neri

et al. 2014

Bone Marrow Transplant

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“…27 Chronic GVHD was diagnosed according to NIH criteria, 18 and the onset was defined at the beginning of systemic treatment. 28 Relapse was defined by hematologic criteria. In addition, any unplanned intervention to prevent progression of malignancy in patients with molecular, cytogenetic or flow cytometric evidence of malignant disease persisting or recurring after HCT was defined as relapse.…”

Section: Patients and Data Collectionmentioning

confidence: 99%

Influence of immunosuppressive treatment on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation

Inamoto

Flowers

Lee

et al. 2011

Blood

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This study was conducted to elucidate the influence of immunosuppressive treatment (IST) and GVHD on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation (HCT). The study cohort included 2656 patients who received allogeneic HCT after highintensity conditioning regimens for treatment of hematologic malignancies. Rates and hazard ratios of relapse and mortality were analyzed according to GVHD and IST as time-varying covariates. Adjusted Cox analyses showed that acute and chronic GVHD were both associated with statistically similar reductions in risk of relapse beyond 18 months after HCT but not during the first 18 months. In patients with GVHD, resolution of GVHD followed by withdrawal of IST was not associated with a subsequent increase in risk of relapse. In patients without GVHD, withdrawal of IST was associated with a reduced risk of relapse during the first 18 months, but the risk of subsequent relapse remained considerably higher than in patients with GVHD. In summary, the association of GVHD with risk of relapse changes over time after HCT. In patients without GVHD, early withdrawal of IST might help to prevent relapse during the first 18 months, but other interventions would be needed to prevent relapse at later time points. (Blood. 2011;118(2): 456-463)

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“…The broad category of acute GvHD also includes persistent, recurrent or late-onset acute GvHD, occurring more than 100 days after transplantation or donor leukocyte infusion. The presence of GvHD without diagnostic or distinctive chronic GvHD manifestations defines the broad category of acute GvHD (Vigorito et al 2009;Jagasia et al 2015).…”

Section: Background To Gvhdmentioning

confidence: 99%

“…The broad category of cGvHD includes classic cGvHD; presenting with manifestations that can be ascribed only to cGvHD, however, it also includes an overlap syndrome, which has diagnostic or distinctive cGvHD manifestations together with features typical of aGvHD (Vigorito et al 2009). …”

Section: Acute Vs Chronic Gvhdmentioning

confidence: 99%

Graft-Versus-Host Disease (GvHD)

Murray

Stringer

Hutt

2017

The European Blood and Marrow Transplantation Textbook for Nurses

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Acute and chronic graft-versus-host disease (GvHD) is a major cause of morbidity and mortality in patients who undergo allogeneic haematopoietic cell transplantation (HCT) and affects approximately 30-40% of recipients. Its diagnosis is complicated, and staging of the disease varies dependent upon the transplant centre involved. Standardisation through the use of National Institute of Health (NIH) guidelines helps clinicians diagnose and treat their patients more effectively. For the majority of patients who go on to develop GvHD, corticosteroids remain the first-line treatment for both acute and chronic GvHD. Recipients that are refractory to systemic steroids have a plethora of second-and third-line options available to them. A 'standard of care' approach has not yet become agreed globally due to poor evidence from small and limited randomised control trials. Supportive care is paramount, and the nurse is often at the centre of the patients care and in the best position to guide and advise the patient and family through this often long-term complication.

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

Cited by 224 publications

References 17 publications

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

Influence of immunosuppressive treatment on risk of recurrent malignancy after allogeneic hematopoietic cell transplantation

Graft-Versus-Host Disease (GvHD)

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