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BleedHD—a new electronic assessment tool for grading chronic graft-versus-host disease validated in a multicenter and multiprofessional setting

Bone Marrow Transplantation volume 58, pages 613–615 (2023)Cite this article

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Chronic graft-versus-host disease (cGvHD) is a frequent long-term complication after allogeneic HCT [1]. Diagnosis and grading of this pleomorphic multiorgan disease are challenging and mainly based on clinical parameters and patient interviews [1]. The National Institute of Health (NIH) consensus conferences have standardized the diagnostic approach [2], but reproducibility between centers and even among different members of the same team remains unsatisfactory [3]. Assessing cGvHD with electronic tools potentially harmonizes and standardizes the diagnostic approach and communication between centers, thereby improving the quality of diagnosis and scoring [4, 5]. The Basel transplant team has developed a digital tool for chronic GvHD assessment (bleedHD) as a web-based application rather than a native app for smartphones or tablets. Details are available in the Supplementary material. The main advantages are the independence from a specific operating system, the fast and low-cost implementation of updates and the possibility to integrate the system into a hospital-based clinical information system. The present study aimed to validate bleedHD on existing patients, applied by health care professionals (HCPs) with different professional background (physicians, nurses, physiotherapists) involved in care of patients after allogeneic HCT.

In the first part of a 2-day workshop, theoretical knowledge on diagnosis and staging of cGvHD was provided. On the second day, 29 HCPs assessed 16 selected patients with established cGvHD for 30 min each. All 16 teams of HCPs examined the organ and overall cGvHD scores using either the NIH 2014 questionnaire in paper form or the electronic application bleedHD on four patients [5, 6]. Thereby, each patient was examined by four different HCP teams—with each tool twice—and additionally, all patients were assessed by a senior physician responsible for the posttransplant care clinic with the largest experience in GvHD assessment, forming an “expert opinion” as comparator for the participants’ assessments. Before the workshop, none of the participants had used bleedHD. The assessments by paper form or bleedHD were compared using the χ2 or Fisher’s exact test for categorical data and Student’s t-test or ANOVA procedure for continuous variables. The global interrater variability of each organ system was calculated using a maximum likelihood estimate for within variability. All tests were two-sided tests and p values <0.05 were considered significant.

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Fig. 1: Chronic GvHD assessment with bleedHD or NIH paper form.

Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Development of the tool was supported by an unrestricted grant from the Regional Blood Transfusion Service SRC, Basel, Switzerland. The present study was supported by a grant from the “Fondazione per la ricerca sulla trasfusione e sui trapianti” and an unrestricted research grant from Novartis to GS. We thank the Transplant team of the University of Basel for their support in the organization and the patients for their participation in this workshop.

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Author notes

  1. These authors contributed equally: Georg Stussi, Jörg Halter.

Authors and Affiliations

  1. Faculty of Medicine, University of Basel, Basel, Switzerland

    Andrea Warthmann, Andreas Holbro, Andreas Buser, Jakob Passweg & Jörg Halter

  2. Division of Hematology, University Hospital Basel, Basel, Switzerland

    Andreas Holbro, Andreas Buser, Sabine Degen Kellerhals, Jakob Passweg & Jörg Halter

  3. Regional Blood Transfusion Service SRC, Basel, Switzerland

    Andreas Holbro & Andreas Buser

  4. Collective Mind GmbH, Leonberg, Germany

    Stefan Schefer

  5. Division of Hematology, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Miriam Ravelli & Georg Stussi

  6. Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

    Georg Stussi

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  1. Andrea Warthmann
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Contributions

GS and JH designed the project, wrote the protocol, and performed the statistical analysis. AW wrote the protocol, was responsible for the acquisition of ethics approval, organization of the workshop, collection, and interpretation of the data. SDK and MR helped to organize the workshop. AB, AH, JP, SS, and JH developed bleedHD. SS was responsible for programming bleedHD. AW wrote the first draft of the manuscript. All authors contributed to data interpretation and writing of the manuscript.

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Correspondence to Georg Stussi.

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The authors declare no competing interests.

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Warthmann, A., Holbro, A., Buser, A. et al. BleedHD—a new electronic assessment tool for grading chronic graft-versus-host disease validated in a multicenter and multiprofessional setting. Bone Marrow Transplant 58, 613–615 (2023). https://doi.org/10.1038/s41409-023-01945-1

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