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Criteria for assessing chronic GVHD

Bone Marrow Transplantation volume 25, page 575 (2000)Cite this article

With reference to the paper by Child et al1 entitled ‘Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD)’, published in your journal we would like to comment on the critical issue of evaluation of chronic graft-versus-host disease, which in our opinion, appears inappropriate in the above cited paper.

Currently accepted standards of evaluating the clinical manifestations of GVHD are based on those described initially by Shulman et al2 and Sullivan et al.3 Child et al have used a new, unvalidated skin scoring system which we find highly questionable. In the ‘Methods’ section the authors describe dermatological features of acute (erythema) and chronic cutaneous lichenoid GVHD and introduce gradings which are not listed in the ‘Results’ section. Moreover, we find it debatable whether erythematous and lichenoid eruptions should be combined with sclerodermatous lesions assessed by a modified Rodnan score, which is otherwise used in the evaluation of patients with progressive systemic sclerosis, to form one skin score. Even mucosal involvement is listed as part of that skin scoring system. We find it difficult to understand a skin score that appears to lump all variants of cutaneous and mucosal GVHD into one score with unvalidated criteria. Therefore, the results described by Child et al cannot be compared with the ones recently published by our group in Blood.4 There, 12 out of 15 patients with steroid-resistant, extensive chronic GVHD achieved a complete response to ECP and another three a partial response of the cutaneous manifestations. In addition, all patients with oral involvement showed a complete response.

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References

  1. Child FJ, Ratnavel R, Watkins P et al. Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-hostdisease (GVHD) Bone Marrow Transplant 1999 23: 881–887

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  2. Shulman HM, Sullivan KM, Weiden PL et al. Chronic graft-versus-host disease syndrome in man Am J Med 1980 69: 204–217

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  3. Sullivan KM, Shulman HM, Storb R et al. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression Blood 1981 57: 267–276

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  4. Greinix HT, Volc-Platzer B, Rabitsch W et al. Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease Blood 1998 92: 3098–3104

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Authors and Affiliations

  1. Department of Medicine I, Bone Marrow Transplantation Unit, University Hospital of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria

    HT Greinix

  2. Department of Dermatology, University Hospital of Vienna, Waehringer Guertel 18-20, Vienna, A-1090, Austria

    B Volc-Platzer & R Knobler

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  1. HT Greinix
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  2. B Volc-Platzer
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  3. R Knobler
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Greinix, H., Volc-Platzer, B. & Knobler, R. Criteria for assessing chronic GVHD. Bone Marrow Transplant 25, 575 (2000). https://doi.org/10.1038/sj.bmt.1702183

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