Incidence and Outcome of Chronic Graft-versus-Host Disease Using National Institutes of Health Consensus Criteria

Abstract

Chronic graft-versus-host disease (cGVHD), a common complication after stem cell transplant (SCT), has an impact on morbidity and survival. Previous classification of cGVHD has not been reproducible or prognostic for nonrelapse mortality (NRM). Recently the National Institutes of Health (NIH) consensus criteria were proposed, but the ability of this classification to predict outcome of various subtypes of cGVHD is unknown. Patients (N = 110) undergoing an SCT for a hematologic malignancy and surviving until day 100 posttransplant from 2001 to 2003 were studied. The overall survival (OS) using a landmark analysis at day 100 was 44% versus 66% (no GVHD vs. GVHD, P = .026). The OS of patients with various types of GVHD as proposed by the NIH criteria were significantly different (P < .0001). In a univariate analyses, this was more apparent when patients with any acute features of GVHD were compared to classic cGVHD (3-year OS 46% vs. 68%, P = .033). The 3-year NRM for the entire cohort was 21%, and was not affected by presence or absence of GVHD or subtypes of GVHD. In a multivariable analysis, extensive cGVHD (hazard ratio [HR] 0.35, P = .015) and having any acute feature of GVHD after day 100 (HR 3.36, P = .0144) were significant independent predictors of survival. The OS with different NIH subtypes of GVHD after day 100 from SCT varies, and is superior for patients with classic cGVHD.

The graft-versus-leukemia effect is mainly restricted to NIH-defined chronic graft-versus-host disease after reduced intensity conditioning before allogeneic stem cell transplantation

“…This result was found for myeloablative conditioning in three out of the five previous studies aiming to reclassify chronic GVHD according to the NIH consensus. [5][6][7][8][9] Although our study highlights the strong GvL effect of chronic GVHD in the setting of RIC, it has the pitfall of being a retrospective analysis. As all patients on study were followed up in our institution, medical records during follow-up allowed a quite well estimate of disease category but did not allow retrospective assignment into NIH-proposed severity scale.…”

“…This proportion of patients with late acute GVHD was lower than that in previously published retrospective studies (15-48%). [5][6][7][8][9] But these studies mixed patients who underwent SCT after myeloablative conditioning and RIC, and for the Seattle's group study patients after myeloablative conditioning who received systemic treatment for chronic GVHD. 5 Our main interest was to search in which disease category, according to the NIH criteria, the GvL effect segregates.…”

“…4 Whether the late acute form of GVHD would have the same potential in reducing relapse rate as classical chronic GVHD is unknown. Although few studies have evaluated the incidence and outcome of chronic GVHD using NIH consensus criteria, [5][6][7][8][9] the incidence and impact of chronic GVHD manifestations defined per NIH consensus criteria after RIC have not been specifically evaluated.…”

Skin response using NIH consensus criteria vs Hopkins scale in a phase II study for steroid-refractory chronic GVHD

“…There have been some recent publications showing that the NIH Consensus staging criteria have applicability: specifically, the severity under the new classification correlates with worse survival and acute features (that is, overlap syndrome) portend worse survival. [7][8][9] These studies were, by necessity, performed with retrospective grading.…”

Clinical characteristics of chronic graft-versus-host disease following umbilical cord blood transplantation for adults

“…In the present study, we assessed the clinical characteristics of chronic GVHD following CBT which were conducted in eight centers of the Nagoya Blood and Marrow Transplantation Group (NBMTG), using the grading systems proposed by Akpek et al 22,23 and the National Institutes of Health (NIH) consensus development project, 24 which are new grading systems in BMT and PBSCT patients. 25,26 Patients and methods…”