Abstract
Chronic GvHD (cGvHD) remains one of the most complex and challenging complications after allogeneic hematopoietic cell transplantation. Emerging knowledge about the clinical manifestations and associated organ involvement of cGvHD has led to the establishment of prognostic parameters for post-transplant survival among affected allograft recipients. Studies employing the pre-National Institutes of Health (NIH) consensus data on cGvHD incidence and its risks have led to development of the CIBMTR’s cGvHD risk stratification, which serves as the most refined and validated prognostic tool for estimating survival of patients with cGvHD. However, cGvHD global severity scoring has recently evolved as a powerful prognostic tool for patient survival in the post-NIH consensus era. Current use of the substantially redefined NIH criteria of cGvHD diagnosis and measurements of its severity makes it challenging to interpret prognostic scoring systems generated in the pre-NIH era. Some of the pre-NIH prognostic parameters, however, appear to retain their significance in predicting survival independently from the NIH global severity score. Thus, future analyses of prospective cohorts of patients with cGvHD defined by NIH consensus criteria will be critical in reconciling and integrating various prognostic scoring systems of cGvHD.
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References
Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med 1980; 69: 204–217.
Kanda J, Nakasone H, Atsuta Y, Toubai T, Yokoyama H, Fukuda T et al. Risk factors and organ involvement of chronic GVHD in Japan. Bone Marrow Transplant 2014; 49: 228–235.
Ozawa S, Nakaseko C, Nishimura M, Maruta A, Cho R, Ohwada C et al. Chronic graft-versus-host disease after allogeneic bone marrow transplantation from an unrelated donor: incidence, risk factors and association with relapse. A report from the Japan Marrow Donor Program. Br J Haematol 2007; 137: 142–151.
Grube M, Holler E, Weber D, Holler B, Herr W, Wolff D . Risk factors and outcome of chronic graft-versus-host disease after allogeneic stem cell transplantation-results from a single-center observational study. Biol Blood Marrow Transplant 2016; 22: 1781–1791.
Atsuta Y, Suzuki R, Yamamoto K, Terakura S, Iida H, Kohno A et al. Risk and prognostic factors for Japanese patients with chronic graft-versus-host disease after bone marrow transplantation. Bone Marrow Transplant 2006; 37: 289–296.
Arora M, Klein JP, Weisdorf DJ, Hassebroek A, Flowers ME, Cutler CS et al. Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis. Blood 2011; 117: 6714–6720.
Moon JH, Sohn SK, Lambie A, Ellis L, Hamad N, Uhm J et al. Validation of National Institutes of Health global scoring system for chronic graft-versus-host disease (GVHD) according to overall and GVHD-specific survival. Biol Blood Marrow Transplant 2014; 20: 556–563.
Wingard JR, Piantadosi S, Vogelsang GB, Farmer ER, Jabs DA, Levin LS et al. Predictors of death from chronic graft-versus-host disease after bone marrow transplantation. Blood 1989; 74: 1428–1435.
Arora M, Burns LJ, Davies SM, Macmillan ML, Defor TE, Miller WJ et al. Chronic graft-versus-host disease: a prospective cohort study. Biol Blood Marrow Transplant 2003; 9: 38–45.
Pavletic SZ, Smith LM, Bishop MR, Lynch JC, Tarantolo SR, Vose JM et al. Prognostic factors of chronic graft-versus-host disease after allogeneic blood stem-cell transplantation. Am J Hematol 2005; 78: 265–274.
Akpek G, Zahurak ML, Piantadosi S, Margolis J, Doherty J, Davidson R et al. Development of a prognostic model for grading chronic graft-versus-host disease. Blood 2001; 97: 1219–1226.
Akpek G, Lee SJ, Flowers ME, Pavletic SZ, Arora M, Lee S et al. Performance of a new clinical grading system for chronic graft-versus-host disease: a multicenter study. Blood 2003; 102: 802–809.
Lee SJ, Klein JP, Barrett AJ, Ringden O, Antin JH, Cahn JY et al. Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse. Blood 2002; 100: 406–414.
Stewart BL, Storer B, Storek J, Deeg HJ, Storb R, Hansen JA et al. Duration of immunosuppressive treatment for chronic graft-versus-host disease. Blood 2004; 104: 3501–3506.
Arora M, Hemmer MT, Ahn KW, Klein JP, Cutler CS, Urbano-Ispizua A et al. Center for International Blood and Marrow Transplant Research chronic graft-versus-host disease risk score predicts mortality in an independent validation cohort. Biol Blood Marrow Transplant 2015; 21: 640–645.
Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.
Inamoto Y, Kim DD, Storer BE, Moon JH, Lipton JH, Kuruvilla J et al. Application of CIBMTR risk score to NIH chronic GVHD at individual centers. Blood 2014; 123: 453–455.
Jacobsohn DA, Arora M, Klein JP, Hassebroek A, Flowers ME, Cutler CS et al. Risk factors associated with increased nonrelapse mortality and with poor overall survival in children with chronic graft-versus-host disease. Blood 2011; 118: 4472–4479.
Arai S, Jagasia M, Storer B, Chai X, Pidala J, Cutler C et al. Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH consensus criteria. Blood 2011; 118: 4242–4249.
Pidala J, Vogelsang G, Martin P, Chai X, Storer B, Pavletic S et al. Overlap subtype of chronic graft-versus-host disease is associated with an adverse prognosis, functional impairment, and inferior patient-reported outcomes: a Chronic Graft-versus-Host Disease Consortium study. Haematologica 2012; 97: 451–458.
Inamoto Y, Martin PJ, Storer BE, Palmer J, Weisdorf DJ, Pidala J et al. Association of severity of organ involvement with mortality and recurrent malignancy in patients with chronic graft-versus-host disease. Haematologica 2014; 99: 1618–1623.
Cho BS, Min CK, Eom KS, Kim YJ, Kim HJ, Lee S et al. Feasibility of NIH consensus criteria for chronic graft-versus-host disease. Leukemia 2009; 23: 78–84.
Kim DY, Lee JH, Lee JH, Kim SH, Lim SN, Kim SD et al. Reevaluation of the National Institutes of Health criteria for classification and scoring of chronic GVHD. Bone Marrow Transplant 2010; 45: 1174–1180.
Perez-Simon JA, Encinas C, Silva F, Arcos MJ, Diez-Campelo M, Sanchez-Guijo FM et al. Prognostic factors of chronic graft-versus-host disease following allogeneic peripheral blood stem cell transplantation: the national institutes health scale plus the type of onset can predict survival rates and the duration of immunosuppressive therapy. Biol Blood Marrow Transplant 2008; 14: 1163–1171.
Perez-Simon JA, Afram G, Martino R, Pinana JL, Caballero-Velazquez T, Ringden O et al. Evaluation of prognostic factors among patients with chronic graft-versus-host disease. Haematologica 2012; 97: 1187–1195.
Ayuk F, Veit R, Zabelina T, Bussmann L, Christopeit M, Alchalby H et al. Prognostic factors for survival of patients with newly diagnosed chronic GVHD according to NIH criteria. Ann Hematol 2015; 94: 1727–1732.
Jagasia M, Giglia J, Chinratanalab W, Dixon S, Chen H, Frangoul H et al. Incidence and outcome of chronic graft-versus-host disease using National Institutes of Health consensus criteria. Biol Blood Marrow Transplant 2007; 13: 1207–1215.
Vigorito AC, Campregher PV, Storer BE, Carpenter PA, Moravec CK, Kiem HP et al. Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD. Blood 2009; 114: 702–708.
Tecchio C, Mosna F, Andreini A, Paoli L, Di Bella R, de Sabata D et al. The National Institutes of Health criteria for classification and scoring of chronic graft versus host disease: long-term follow-up of a single center series. Leuk Lymphoma 2013; 54: 1020–1027.
Baird K, Steinberg SM, Grkovic L, Pulanic D, Cowen EW, Mitchell SA et al. National Institutes of Health chronic graft-versus-host disease staging in severely affected patients: organ and global scoring correlate with established indicators of disease severity and prognosis. Biol Blood Marrow Transplant 2013; 19: 632–639.
Palmer J, Williams K, Inamoto Y, Chai X, Martin PJ, Tomas LS et al. Pulmonary symptoms measured by the national institutes of health lung score predict overall survival, nonrelapse mortality, and patient-reported outcomes in chronic graft-versus-host disease. Biol Blood Marrow Transplant 2014; 20: 337–344.
Pidala J, Chai X, Martin P, Inamoto Y, Cutler C, Palmer J et al. Hand grip strength and 2-minute walk test in chronic graft-versus-host disease assessment: analysis from the Chronic GVHD Consortium. Biol Blood Marrow Transplant 2013; 19: 967–972.
Arai S, Pidala J, Pusic I, Chai X, Jaglowski S, Khera N et al. A randomized phase II crossover study of imatinib or rituximab for cutaneous sclerosis after hematopoietic cell transplantation. Clin Cancer Res 2016; 22: 319–327.
Carpenter PA, Logan B, Lee S, Weisdorf D, Johnston L, Costa L et al. Prednisone (PDN)/sirolimus (SRL) compared to PDN/SRL/calcineurin inhibitor (CNI) as treatment for chronic graft-versus-host-disease (cGVHD): a randomized phase II study from the Blood and Marrow Transplant Clinical Trials Network. Biol Blood Marrow Transplant 2016; 22: S50–S52.
Inamoto Y, Martin PJ, Chai X, Jagasia M, Palmer J, Pidala J et al. Clinical benefit of response in chronic graft-versus-host disease. Biol Blood Marrow Transplant 2012; 18: 1517–1524.
Jacobsohn DA, Kurland BF, Pidala J, Inamoto Y, Chai X, Palmer JM et al. Correlation between NIH composite skin score, patient-reported skin score, and outcome: results from the Chronic GVHD Consortium. Blood 2012; 120: 2545–2552 quiz 2774.
Lee S, Cook EF, Soiffer R, Antin JH . Development and validation of a scale to measure symptoms of chronic graft-versus-host disease. Biol Blood Marrow Transplant 2002; 8: 444–452.
Spinelli S, Chiodi S, Costantini S, Van Lint MT, Raiola AM, Ravera GB et al. Female genital tract graft-versus-host disease following allogeneic bone marrow transplantation. Haematologica 2003; 88: 1163–1168.
Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL . Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 2000; 118: 615–621.
Bron AJ, Evans VE, Smith JA . Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea 2003; 22: 640–650.
Inamoto Y, Chai X, Kurland BF, Cutler C, Flowers ME, Palmer JM et al. Validation of measurement scales in ocular graft-versus-host disease. Ophthalmology 2012; 119: 487–493.
Pidala J, Kurland BF, Chai X, Vogelsang G, Weisdorf DJ, Pavletic S et al. Sensitivity of changes in chronic graft-versus-host disease activity to changes in patient-reported quality of life: results from the Chronic Graft-versus-Host Disease Consortium. Haematologica 2011; 96: 1528–1535.
First LR, Smith BR, Lipton J, Nathan DG, Parkman R, Rappeport JM . Isolated thrombocytopenia after allogeneic bone marrow transplantation: existence of transient and chronic thrombocytopenic syndromes. Blood 1985; 65: 368–374.
Pulanic D, Lozier JN, Pavletic SZ . Thrombocytopenia and hemostatic disorders in chronic graft versus host disease. Bone Marrow Transplant 2009; 44: 393–403.
Inamoto Y, Storer BE, Lee SJ, Carpenter PA, Sandmaier BM, Flowers ME et al. Failure-free survival after second-line systemic treatment of chronic graft-versus-host disease. Blood 2013; 121: 2340–2346.
Palmer J, Chai X, Pidala J, Inamoto Y, Martin PJ, Storer B et al. Predictors of survival, nonrelapse mortality, and failure-free survival in patients treated for chronic graft-versus-host disease. Blood 2016; 127: 160–166.
Lee SJ, Wolff D, Kitko C, Koreth J, Inamoto Y, Jagasia M et al. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: IV. The 2014 Response Criteria Working Group report. Biol Blood Marrow Transplant 2015; 21: 984–999.
Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 2015; 21: 389–401.e1.
Acknowledgements
This project was supported in part by the Immune Mediated Disorders After Allogeneic HCT grant U54CA163438 (AL). The cGvHD Consortium (U54 CA163438) is part of the NCATS Rare Diseases Clinical Research Network (RDCRN). RDCRN is an initiative of the Office of Rare Disease Research (ORDR), NCATS, funded through collaboration between NCATS and the National Cancer Institute. The funding organization had no role in producing this manuscript. We gratefully acknowledge Michael Franklin, MS, for his assistance in editing the manuscript.
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Lazaryan, A., Arora, M. Evolving concepts in prognostic scoring of chronic GvHD. Bone Marrow Transplant 52, 1361–1366 (2017). https://doi.org/10.1038/bmt.2017.50
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DOI: https://doi.org/10.1038/bmt.2017.50
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