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Graft-Versus-Host Disease

NIH response criteria measures are associated with important parameters of disease severity in patients with chronic GVHD

Bone Marrow Transplantation volume 49, pages 1513–1520 (2014)Cite this article

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Abstract

Lack of standardized criteria measuring therapeutic response remains an obstacle to the development of better treatments for chronic GVHD (cGVHD). This cross-sectional prospective study examined the concurrent and predictive validity of 18 clinician-reported (‘Form A’) and 8 patient-reported (‘Form B’) response measures proposed by NIH criteria. Concurrent parameters of interest were NIH global score, cGVHD activity, Lee symptom score and SF36 PCS. Patient cohort included 193 adults with moderate-to-severe cGVHD. Measures associated with the highest number of outcomes were lung function score (LFS), 2-min walk, grip strength, 4-point health-care provider (HCP) and patient global scores, 11-point clinician- and patient-reported global symptom severity scores, and Karnofsky performance score (KPS). Measures associated with survival in univariate analyses led to a Cox model containing skin erythema, LFS, KPS, eosinophil count and interval from cGVHD diagnosis to enrollment as jointly associated with survival. In conclusion, 4-point HCP and patient global scores and 11-point clinician- and patient-reported global symptom severity scores are associated with the majority of concurrent outcomes. Skin erythema is a potentially reversible sign of cGVHD that is associated with survival. These results define a subset of measures that should be prioritized for evaluation in future studies.

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Acknowledgements

This research was also supported also by National Institutes of Health, Clinical Center, Nursing and Patient Care Services. We thank all patients and their families who participated in the natural history of cGVHD protocol. This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, Center for Cancer Research. The authors are employees of the United States Government, and, as such, this work was carried out in that capacity. The views expressed do not necessarily represent the views of the National Institutes of Health or the United States Government.

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Author notes

  1. L M Curtis and L Grkovic: Shared first authorship.

Authors and Affiliations

  1. Medical Oncology Service, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA

    L M Curtis

  2. Experimental Transplantation and Immunology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA

    L M Curtis, L Grkovic, D Avila, T Taylor, K Cole, J Baruffaldi, D H Fowler, R E Gress & S Z Pavletic

  3. Department of Hematology, Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia

    L Grkovic & D Pulanic

  4. Outcomes Research Branch; Division of Cancer Control and Population Sciences, National Institutes of Health, National Cancer Institute,

    S A Mitchell

  5. Division of Cancer Control and Population Sciences, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA

    S A Mitchell

  6. Biostatistics and Data Management Section, National Institutes of Health, National Cancer Institute, Rockville, MD, USA

    S M Steinberg

  7. Dermatology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA

    E W Cowen

  8. National Institutes of Health, National Eye Institute, Bethesda, MD, USA

    M B Datiles

  9. National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA

    J Mays & C Bassim

  10. Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

    G Joe & L E Comis

  11. Pain and Palliative Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

    A Berger

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  1. L M Curtis
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Corresponding author

Correspondence to S Z Pavletic.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Curtis, L., Grkovic, L., Mitchell, S. et al. NIH response criteria measures are associated with important parameters of disease severity in patients with chronic GVHD. Bone Marrow Transplant 49, 1513–1520 (2014). https://doi.org/10.1038/bmt.2014.188

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