Feasibility of NIH consensus criteria for chronic graft-versus-host disease

Abstract

To assess the applicability of the National Institutes of Health (NIH) consensus criteria (NCC) for chronic graft-versus-host disease (cGVHD), 211 patients who developed GVHD more than 100 days after allogeneic transplantation were reclassified using NCC. Classifications were: late acute GVHD (44 patients, 21%), overlap syndrome (64 patients, 30%) and classic cGVHD (103 patients, 49%). Classic cGVHD and overlap syndrome patients (n ¼ 167) were graded using both the revised Seattle criteria (RSC) and NIH global scoring (NGS). Twenty-three patients (14%) had mild, 81 (48%) had moderate and 63 (38%) had severe cGVHD. After a median follow-up of 46 months (range 5-71 months), the 4-year GVHD-specific survival was not significantly different among the different subtypes of NCC. Among patients with late acute GVHD, however, the pattern of acute GVHD onset (late, persistent or recurrent) was significantly different with respect to GVHD-specific survival. Among patients with overlap syndrome and classic cGVHD, multivariate analysis showed that NGS as well as RSC were useful in predicting survival and discontinuation of immunosuppressive therapy despite of more detailed grouping. Our study indicates that NCC is applicable. The clinical impact of NIH types and NGS should be verified through prospective studies.

Optimal management of chronic graft‐versus‐host disease in children

“…The presence of some of these criteria (thrombocytopenia, extensive skin involvement, progressive onset, weight loss, diarrhoea, low Karnofsky performance score) in a patient may prompt a physician to treat more aggressively at the diagnosis of chronic GVHD. It is now appreciated that some of these criteria may actually point to persistent manifestations of acute GVHD (late acute, overlap syndrome) rather than pure chronic GVHD (Filipovich et al, 2005;Cho et al, 2009;Jagasia et al, 2009).…”

A novel protocol for haploidentical hematopoietic SCT without in vitro T-cell depletion in the treatment of severe acquired aplastic anemia

“…10,11 The incidence and severity of GVHD were based on a NIH consensus conference to determine GVHD grade. 12 Patients were evaluated for cGVHD if they survived for at least 100 days after HSCT.…”

Chronic GVHD induced GVL effect after unmanipulated haploidentical hematopoietic SCT for AML and myelodysplastic syndrome

“…Subsequently, several studies observed that NIH global scoring was useful for predicting NRM and GVHD-specific survival. 7,8 However, relatively few reports have examined the association between NIH global scoring and either relapse or DFS after HSCT.…”