New clinical grading system for chronic GVHD predicts duration of systemic immunosuppressive treatment and GVHD-specific and overall survival

Abstract

We investigated outcomes according to a new clinical grading system for chronic graft-versus-host disease (chronic GVHD) in 38 patients who developed chronic GVHD after an allogeneic hematopoietic stem cell transplantation. We categorized the patients into three grade groups, namely, grade I, grade II and grade III, according to the presence of three risk factors: extensive skin involvement, thrombocytopenia (TP) and progressive type of onset. Sixteen patients were classified into grade 1, 19 into grade II and three into grade III. The probability of withdrawal of systemic immunosuppression (IST) at 1, 2 and 3 years was 61, 76 and 87%, respectively. Patients with grades 2 or 3 chronic GVHD had prolonged duration of systemic IST compared to grade 1 (P ¼ 0.043). The probability of GVHD-specific survival (GSS) at 5 years was 52%. Twenty-two of 38 patients with chronic GVHD were still alive and the estimated 3-year overall survival (OS) rate was 60%, whereas that for the group with chronic GVHD grade I and grade II þ III was 64 and 48% (Po0.05). Multivariate analysis showed that prior occurrence of acute GVHD, chronic GVHD grade, serum bilirubin over 1.5 mg/dl, date of diagnosis of chronic GVHD (oday 150 versus 4day 150) and transplantation-risk factor were independent prognostic factors for GSS and OS.

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

“…36,37 Lastly, all of the patients with chronic GVHD were classified as belonging to the favorable risk group according to the new grading systems. [22][23][24] Thus, these findings demonstrate that although chronic GVHD is a significant complication in CBT, its characteristics are different from those of GVHD following BMT and PBSCT; it is mild and infrequent. The clinical courses of chronic GVHD after CBT may be related to the immature lymphocytes in cord blood which are immunologically tolerant, 41,42 while the basic mechanism has been unknown and awaits further investigations.…”

“…Second, a new prognostic model that can be applied to CBT needs to be established. In the present study, most of the patients were classified as belonging to one group, the favorable risk group, according to the grading system proposed both by Akpek et al and the NIH consensus development project; [22][23][24] thus, they may not be useful for classifying patients with chronic GVHD after CBT. Finally, patients with chronic GVHD were treated according to the strategy established for BMT.…”

“…27,28 Patients with chronic GVHD were also assigned a grade according to the criteria proposed by Akpek et al, 22,23 which include extent of skin involvement, platelet count and progressive-type onset. The scoring for the criteria is as follows: (1) if the extent of skin involvement is more than 50% of body surface area, allocate 1, otherwise 0; (2) if the platelet count is less than 100 Â 10 9 /l, allocate 1, otherwise 0 and (3) if the chronic GVHD is progressive-type onset, allocate 1, otherwise 0.…”

“…21 Given that chronic GVHD is a major complication for long-term survivors, the clinical characteristics of CBT patients with chronic GVHD need to be investigated to improve these patients' outcomes. 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…”

Indoleamine 2,3-Dioxygenase in Human Hematopoietic Stem Cell Transplantation

“…GvHD can occur in an acute or chronic form with 100 days after HSCT being the widely accepted cut-off time point to discriminate acute from chonic GvHD 11. The distinction between acute and chronic GvHD is clinically relevant as both, the clinical appearance as well as the pathogenesis are seemingly different and may require different treatment 12–14. Chronic GvHD may resemble a chronic autoimmune disease rather than the acute form.…”