New classification of chronic GVHD: added clarity from the consensus diagnoses

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. 2; pp. 149 - 153
• Main Authors: Arora, M, Nagaraj, S, Witte, J, DeFor, T E, MacMillan, M, Burns, L J, Weisdorf, D J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-01-2009; Nature Publishing Group
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Chronic Disease; Clinical trials; Complications and side effects; Criteria; Demographic aspects; Development projects; Diagnosis; Female; Graft versus host reaction; Graft vs Host Disease - diagnosis; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Internal Medicine; Kaplan-Meier Estimate; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; original-article; Outcome and process assessment (Health Care); Patient outcomes; Patients; Public Health; Risk factors; Stem cell transplantation; Stem Cells; Survival; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning; Transplantation of organs, tissues, etc; Young Adult; United States; classification; consensus guidelines; CGVHD; Immunopathology; Graft versus host disease; Chronic; Hematology; Stem cell; Classification; Hematopoietic cell; Diagnosis; Consensus; Recommendation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.305

The Diagnosis and Staging Working Group of the NIH Consensus Development Project on Criteria for Clinical Trials in chronic GVHD (CGVHD) recently proposed criteria for diagnosis and assessment of overall CGVHD severity. We retrospectively reviewed 54 consecutive patients diagnosed with CGVHD between January 2002 and December 2005 after sibling donor transplant to assess the applicability of the new criteria in prognosticating survival and transplant-related mortality (TRM). A total of 8 patients (15%) were reclassified as late onset/persistent or recurrent acute GVHD (late aGVHD), 15 (28%) had overlap syndrome and 31 (57%) had classic CGVHD. Three-year overall survival was worse in patients with late aGVHD (3-year probability 25% (95% CI 4–56%)) followed by overlap syndrome (3-year probability 87% (95% CI 56–96%)) and CGVHD (3-year probability 75% (95% CI 54–87%));
P
=0.001. Among patients with overlap syndrome and CGVHD, a trend towards worse survival was seen in patients with severe disease (3-year probability 57.3% (95% CI 21–82%)) as compared to mild+moderate disease (3-year probability 85.1% (95% CI 68–94));
P
=0.1. This analysis, undertaken in a contemporary cohort of related donor recipients, indicates that the consensus guidelines are applicable to this population of CGVHD patients.