Validation of National Institutes of Health Global Scoring System for Chronic Graft-Versus-Host Disease (GVHD) According to Overall and GVHD-Specific Survival

Abstract

A new severity grading system for graft-versus-host disease (GVHD) was established by the National Institutes of Health (NIH) consensus criteria (NCC). However, its prognostic value still needs to be validated. Four hundred twenty-five consecutive patients who survived beyond 100 days after allogeneic stem cell transplantation were reviewed and reclassified using NCC. GVHD-specific survival (GSS) and cumulative incidence of relapse were compared according to the NIH global score at the onset and peak of chronic GVHD (cGVHD). Of 346 patients with cGVHD diagnosed by the Revised Seattle Criteria, 317 patients were reclassified according to the NCC as classic cGVHD (n = 144) and overlap syndrome (n = 173). The NIH global scores at onset were mild (43.2%), moderate (42.3%), and severe (14.5%), whereas more moderate (55.5%) and severe (31.6%) cGVHD was observed at the peak of cGVHD. With a median follow-up duration of 34 months, the 5-year GSS was significantly worse for the severe group than the moderate/mild groups at onset and at peak: 50.9% ± 7.8% versus 89.7% ± 3.2% versus 93.5% ± 2.4% at onset (P < .001) and 69.1% ± 5.2% versus 93.2% ± 2.1% versus 97.3% ± 2.7% at peak (P < .001). Severe NIH global score at onset and peak were confirmed as a poor prognostic factor for GSS in multivariate analysis. The cumulative incidence of relapse did not differ among the severity groups at onset or peak. In conclusion, the new NIH global scoring system was shown to differentiate a high-risk group of patients (with severe grade cGVHD) in terms of long-term transplant outcomes.

Risk Factors and Outcome of Chronic Graft-versus-Host Disease after Allogeneic Stem Cell Transplantation—Results from a Single-Center Observational Study

“…Furthermore, patients with severe cGVHD had a significantly higher TRM compared with patients with mild or moderate cGVHD. Our data are in accordance with recent studies that reported a correlation between cGVHD severity and outcome after allo-SCT and it is suggested that patients with severe cGVHD represent an unfavorable subgroup [3,11,18,27,38,55,56,[58][59][60][61][62]66,67].…”

“…In accordance with recently published studies, we found a significantly lower incidence of relapse in patients with compared with patients without cGVHD and this might be caused by a graft-versus-leukemia effect similar to that of aGVHD [2,11,18,27,55,60,[71][72][73]. Patients with severe (but not with mild or moderate) cGVHD had a significantly lower relapse rate compared with patients without cGVHD.…”

“…When we analyzed the impact of cGVHD on the outcome of patients after allo-SCT, we observed a significantly higher incidence of TRM and lower OS in patients with progressive rather than de novo or quiescent onset of cGVHD, which is in accordance with several other studies [3,18,[53][54][55][56][57]. Furthermore, we confirmed the prognostic relevance of a platelet count below 100/nL at the time of cGVHD onset, which is significantly associated with worse outcome [3,38,53,55,56,[58][59][60][61][62][63]. Low platelets may be an indicator for increased platelet turnover, as recently described in cGVHD [64], and decreased production of platelets, which has been demonstrated in an experimental transplantation model for aGVHD [65].…”

Recent advances in the management of graft-versus-host disease

“…Moreover, this approach enables more consistent assessment and treatment of cGvHD and improved evaluation of outcomes. The system's prognostic value has been validated in an independent adult cohort in whom a severe score was associated with significantly increased risk of death from cGvHD or causes related to its treatment,32 but has not been confirmed yet in children.…”

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)

“…Il lui est également demandé d'évaluer ses symptômes dans différents organes (annexe 3) et/ou de rapporter sa qualité de vie à l'aide d'un questionnaire standardisé (annexe 4). Il a été démontré que le score de sévérité au diagnostic de la GvHc [15] et la réponse au traitement non confirmé par Inamoto et al [16], ont une valeur prédictive de la possibilité de sevrer les patients du traitement immunosuppresseur et de leur survie. Il est parfois très difficile, notamment pour les formes scléro-dermiques, de distinguer une GvHc active qui nécessite la poursuite du traitement immunosuppresseur de séquelles fixées d'une GvHc qui n'est plus du tout active et pour laquelle le traitement pourrait être arrêté.…”