NIH Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. The 2014 Pathology Working Group Report

Abstract

The 2005 National Institute of Health (NIH) Consensus Conference outlined histopathological diagnostic criteria for the major organ systems affected by both acute and chronic graft-versus-host disease (GVHD). The 2014 Consensus Conference led to this updated document with new information from histopathological studies of GVHD in the gut, liver, skin and oral mucosa and expanded discussion of GVHD in the lungs and kidneys. The recommendations for final histological diagnostic categories have been simplified from 4 categories to 3: no GVHD, possible, and likely GVHD based on better reproducibility achieved by combining the previous categories of consistent with and definite GVHD into the single category of likely GVHD. Issues remain in the histopathological characterization of GVHD, particularly with respect to the threshold of histological changes required for diagnostic certainty. Guidance is provided for the incorporation of biopsy information into prospective clinical studies of GVHD, particularly with respect to biomarker validation.

Consensus diagnostic histopathological criteria for acute gastrointestinal graft versus host disease improve interobserver reproducibility

“…Shortcomings of established grading schemes such as Lerner histologic grading [10] and related modifications [14,20] have been pointed out in earlier [15] and recent [16] consensus documents dealing with the histopathological diagnosis of gastrointestinal GvHD. Firstly, diagnostic criteria for a minimal degree of GvHD are not standardized and subject to individual variation.…”

“…The diagnosis of GvHD relies on clinical symptoms andespecially in non-diagnostic or precarious clinical settingson histopathological findings [15]. However, assessment of severity of GvHD on histology, by grading the characteristic histological features, is often only weakly correlated with the clinical course of the disease [1,16,21,23].…”

Chronic graft-versus-host disease: biological insights from preclinical and clinical studies

“…[1][2][3] Progress in improving cGVHD prevention and therapy has been hindered by complexities in cGVHD diagnosis and staging, 4,5 lack of uniform treatment response criteria, 6 paucity of controlled trials, 7 and access to new therapies with an established proof-of-concept or strong pathophysiological basis in preclinical models. Such progress has been supported by analysis of human materials acquired from cGVHD patients.…”

Prise en charge de la maladie du greffon contre l’hôte chronique : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC)

“…De plus, de nouvelles options thérapeutiques ont été publiées [2][3][4][5][6][7][8]. Le groupe de travail des ateliers 2016 a revu les conclusions des ateliers 2012 et la littérature récente, dont notamment la révision des recommandations du NIH [9][10][11][12][13]. Le travail a été conduit selon les recommandations des ateliers d'harmonisation des pratiques de la SFGM-TC [14].…”